Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.06.001
Brazilian Journal of Anesthesiology
Review Article

Noninvasive hemoglobin monitoring in clinical trials: a systematic review and meta-analysis

Monitorização não invasiva da hemoglobina em ensaios clínicos: uma revisão sistemática e metanálise

Daniele Paola da Silva Wizbicki, Tailyne Zortea, Kristian Madeira, Edson Souza Machado Duraes

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Abstract

Background and objectives
The measurement of Hb by co-oximetry is an innovative technique that offers efficiency and agility in the processing of information regarding the measurement of Hemoglobin concentration (Hb) obtained through continuous, non-invasive and rapid monitoring. Because of this attribute, it avoids unnecessary exposures of the patient to invasive procedures by allowing a reduction in the number of blood samples for evaluation and other unnecessary therapies. It also helps to make decisions about the need for transfusion and how to handle it. The objective of this study is to compare the performance offered to obtain Hb values between the Masimo Corporation (Irvine, CA, USA) instrument and the standard gold tool (laboratory examination).

Contents
The study corresponds to a systematic review followed by meta-analysis, which included fully registered full-text clinical trials published from 1990 to 2018. PubMed, Cochrane, Medline, Embase and Web of Science databases were investigated. The mean overall difference found between the non-invasive and invasive methods of hemoglobin monitoring was 0.23 (95% CI -0.16, 0.62), that is, it did not present statistical significance (p = 0.250). The results of the analysis of heterogeneity within and between the studies indicated high levels of inconsistency (Q = 461.63, p < 0.0001, I2 = 98%), method for Hb values.

Conclusions
Although the mean difference between noninvasive measurements of Hb and the gold standard method is small, the co-oximeter can be used as a non-invasive “trend” monitor in detecting unexpected responses at Hb levels.

Keywords

Spectrophotometry;  Oximetry;  Blood chemical analysis;  Blood gas monitoring transcutaneous;  Clinical trial;  Systematic review;  Meta-analysis

Resumo

Justificativa
A medida da Hb por co-oximetria é uma técnica inovadora que oferece eficiência e agilidade no processamento das informações referentes a medida da concentração de Hemoglobina (Hb) obtida por meio de monitorização contínua, não-invasiva e rápida. Por conta desse atributo, evita exposições desnecessárias do paciente a procedimentos invasivos ao possibilitar redução da quantidade de amostras sanguíneas para avaliação e de outras terapêuticas desnecessárias. Além disso, auxilia a tomada de decisões quanto a necessidade de transfusão e quanto ao manejo da mesma.

Objetivo
Comparar o desempenho oferecido para a obtenção dos valores de Hb entre medida não invasiva da Hb e a ferramenta padrão ouro (exame laboratorial).

Conteúdo
O estudo corresponde a uma revisão sistemática seguida de metanálise, que incluiu ensaios clínicos devidamente registrados com texto completo, publicados a partir de 1990 até 2018. Foram investigadas as bases de dados PubMed, Cochrane, Medline, Embase e Web Of Science. A diferença média global encontrada entre os métodos não invasivo e invasivo de monitorização da hemoglobina foi de 0,23 (95% IC -0,16; 0,62), ou seja, não apresentou significância estatística (p = 0,250). Os resultados da análise de heterogeneidade dentro e entre os estudos, apontou níveis elevados de inconsistência (Q = 461,63, p < 0,0001, I2 = 98%).

Conclusão
Embora a diferença média entre as medidas não invasivas da Hb e o método padrão ouro sejam pequenas, o co-oxímetro pode ser utilizado como um monitor não invasivo de “tendência” na detecção de alterações inesperadas nos níveis de Hb.

Palavras-chave

Espectrofotometria;  Oximetria;  Análise química do sangue;  Monitorização transcutânea dos gases sanguíneos;  Ensaio clínico;  Revisão sistemática;  Metanálise

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