Continuous Noninvasive Hemoglobin Monitoring: A Measured Response to a Critical Review.
Michael A.E. Ramsay, M.D.
Barker, S. J., A. Shander and M. A. Ramsay (2016). “Continuous Noninvasive Hemoglobin Monitoring: A Measured Response to a Critical Review.” Anesth Analg 122(2): 565-572.
SpHb accuracy may eventually improve to the point where it can actually replace invasive blood sampling and lab analysis (lab-Hb). In the meantime, SpHb monitoring can and will supplement lab-Hb continuously between individual lab-Hb measurements. SpHb monitoring is a technological breakthrough because it allows real-time, continuous evaluation of changes (or absence of changes) of Hb levels. There are already thousands of SpHb devices in clinical use around the world. Although the technology and its accuracy are still improving, SpHb has repeatedly demonstrated clinically usable accuracy in head-to-head comparisons with lab-Hb and similar trend accuracy (precision) as invasive methods. Most importantly, because of its continuous, noninvasive trending ability, SpHb monitoring has been shown to help clinicians reduce RBC transfusions and initiate more timely RBC transfusions when they are needed. In occult bleeding patients, SpHb has helped save lives and enhance the quality of care. Clinicians should carefully consider the appropriate role for SpHb monitoring in their practice and thereby establish appropriate criteria for performance. Twenty years from now, we will hopefully look back on the advent of SpHb monitoring and marvel at the impact it has had on patient safety, quality, and cost of care, just like we do today with pulse oximetry. (No abstract; excerpt from text.)