Undetected Intraoperative Blood Loss
Conditions
Brief summary
Certain types of surgery are associated with occult blood loss, which is hard to detect intraoperatively by intermittent conventional, invasive Hb concentration measurements using the clinical standard of Hb monitoring by satellite laboratory analysis (Hbsatlab). The investigators want to see whether continuous non-invasive transcutaneous Hb measurement using a finger sensor (SpHb), (a) reduces the total time (area under the curve, AUC) a patient's Hb is below a predetermined transfusion threshold (HbAUC) for administration of red blood cell concentrate (RBC), and (b) prevents a decrease in total oxygen delivery (DO2) possibly associated with transfusion below a critical haemoglobin concentration. Furthermore, the investigators want to study if SpHb monitoring changes the timing of RBC administration and reduces the need for intra- and post-operative RBC transfusion.
Interventions
PROCEDUREblood transfusion, intermittent Hbsatlab measurement
In the Hbsatlab group, RBC administration and its timing will be based on intermittent Hbsatlab measurement (routine care)
PROCEDUREblood transfusion, based on continuous SpHb readings
RBC administration and its timing will be based on continuous SpHb readings while Hbsatlab values, measured every 30 min. by an objective observer, will not be visible to the attending anaesthetist.
Sponsors
University Medical Center Groningen
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients at the age of 18 years or older, planned for elective surgery at-risk for undetected blood loss. * American Society of Anesthesiologists (ASA) classification I, II, III, IV
Exclusion criteria
* Patient refusal * Emergency surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HbAUC | during operation | the total time a patient's Hb is below a predetermined transfusion threshold (HbAUC) for administration of red blood cell concentrate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| blood transfusions | intra- and post operative up to 48h | the number of perioperative blood transfusions |
Other
| Measure | Time frame | Description |
|---|---|---|
| DO2 | intraoperative | DO2 = oxygen delivery |
| serum concentrations of high-sensitive troponin T | post operative up to 48h | serum concentrations of high-sensitive troponin T |
| serum concentrations of lactate | intra- and post operative up to 48h | lactate |
| StO2 | intraoperative | StO2 = peripheral tissue oxygenation by near-infrared spectroscopy |
Countries
Netherlands
Outcome results
None listed