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Pediatric Critical Care Medicine : a... Jul 2015Neurologic injury remains a significant morbidity and risk factor for mortality in critically ill patients undergoing extracorporeal membrane oxygenation. Our goal was... (Review)
Review
OBJECTIVE
Neurologic injury remains a significant morbidity and risk factor for mortality in critically ill patients undergoing extracorporeal membrane oxygenation. Our goal was to systematically review the literature on the use of neuromonitoring methods during extracorporeal membrane oxygenation.
DATA SOURCES
Electronic searches of PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Scopus were conducted in March 2014, using a combination of medical subject heading terms and text words to define concepts of extracorporeal life support, neurologic monitoring techniques, evaluation, and outcomes.
STUDY SELECTION
Studies were selected based on inclusion and exclusion criteria defined a priori.
DATA EXTRACTION
Two authors reviewed all citations independently. A standardized data extraction form was used to construct evidence tables by neuromonitoring method. Evidence was graded using the Oxford Evidence-Based Medicine scoring system.
DATA SYNTHESIS
Of 3,459 unique citations, 39 studies met the inclusion criteria. Study designs were retrospective observational cohort studies (n = 20), prospective observational studies (n = 17), case-control studies (n = 2), and no interventional studies. Most studies evaluated newborns (n = 30). Extracorporeal membrane oxygenation neuromonitoring methods included neuroimaging (head ultrasound) (n = 12); intermittent, conventional, multichannel electroencephalography (n = 5); 1- to 2-channel amplitude-integrated electroencephalography (n = 2); Doppler ultrasound (n = 7); cerebral oximetry (n = 6); plasma brain injury biomarkers (n = 4); and other (n = 3). All evidence was graded 2B-4, with the majority of studies graded 3B (20/39 studies) and 4 (10/39 studies). Due to the heterogeneity of the studies included, aggregate analysis was not possible.
CONCLUSIONS
Data supporting the use and effectiveness of current neuromonitoring methods are limited. Most studies have modest sample sizes, are observational in nature, and include patient populations that are of different ages and pathologies, with very limited data for pediatric and adult ages. Well-designed studies with adequate power and standardized short- and long-term outcomes are needed to develop guidelines for neuromonitoring and ultimately neuroprotection in patients on extracorporeal membrane oxygenation.
Topics: Biomarkers; Brain Injuries; Electroencephalography; Extracorporeal Membrane Oxygenation; Humans; Neuroimaging; Neurophysiological Monitoring; Oximetry; Ultrasonography, Doppler
PubMed: 25828783
DOI: 10.1097/PCC.0000000000000415 -
European Journal of Emergency Medicine... Aug 2023Carbon monoxide (CO) poisoning is one of the most common causes of poisoning death and its diagnosis requires an elevated carboxyhemoglobin (COHb) level. Noninvasive CO... (Meta-Analysis)
Meta-Analysis
Carbon monoxide (CO) poisoning is one of the most common causes of poisoning death and its diagnosis requires an elevated carboxyhemoglobin (COHb) level. Noninvasive CO saturation by pulse oximetry (SpCO) has been available since 2005 and has the advantage of being portable and easy to use, but its accuracy in determining blood COHb level is controversial. To evaluate the accuracy of SpCO (index test) to estimate COHb (reference test). Systematic review and meta-analysis of diagnostic test accuracy (DTA) studies. Four electronic databases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials, and OpenGrey) on 2 August 2022. All studies of all designs published since the 2000s evaluating the accuracy and reliability of SpCO measurement compared to blood COHb levels in human volunteers or ill patients, including children, were included. The primary outcome was to assess the diagnostic accuracy of SpCO for estimating COHb by blood sampling by modeling receiver operating characteristic (ROC) curves and calculating sensitivity and specificity (primary measures). The secondary measures were to calculate the limits of agreement (LOA) and the mean bias. This systematic review was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis-DTA 2018 guidelines and has been registered on International Prospective Register of Systematic Reviews (PROSPERO, CRD42020177940). The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Twenty-one studies were eligible for the systematic review; 11 could be included for the quantitative analysis of the primary measures and 18 for the secondary measures. No publication bias was found. The area under the summary ROC curve was equal to 86%. The mean sensitivity and specificity were 0.77, 95% confidence interval (CI, 0.66-0.85) and 0.83, 95% CI (0.74-0.89), respectively (2089 subjects and 3381 observations). The mean bias was 0.75% and the LOA was -7.08% to 8.57%, 95% CI (-8.89 to 10.38) (2794 subjects and 4646 observations). Noninvasive measurement of COHb (SpCO) using current pulse CO oximeters do not seem to be highly accurate to estimate blood COHb (moderate sensitivity and specificity, large LOA). They should probably not be used to confirm (rule-in) or exclude (rule-out) CO poisoning with certainty.
Topics: Child; Humans; Carboxyhemoglobin; Reproducibility of Results; Oximetry; Carbon Monoxide Poisoning; Diagnostic Tests, Routine
PubMed: 37171830
DOI: 10.1097/MEJ.0000000000001043 -
Journal of Global Health Sep 2023Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use...
BACKGROUND
Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use in lower resource settings. Pulse oximetry training initiatives have been ongoing for years, but a map of the literature describing such initiatives among health care workers in low- and middle-income countries (LMICs) has not previously been conducted. Additionally, the coronavirus disease 2019 (COVID-19) pandemic further highlighted the inequitable distribution of pulse oximetry use and training. We aimed to characterise the landscape of pulse oximetry training for health care workers in LMICs prior to the COVID-19 pandemic as described in the literature.
METHODS
We systematically searched six databases to identify studies reporting pulse oximetry training among health care workers, broadly defined, in LMICs prior to the COVID-19 pandemic. Two reviewers independently assessed titles and abstracts and relevant full texts for eligibility. Data were charted by one author and reviewed for accuracy by a second. We synthesised the results using a narrative synthesis.
RESULTS
A total of 7423 studies were identified and 182 screened in full. A total of 55 training initiatives in 42 countries met inclusion criteria, as described in 66 studies since some included studies reported on different aspects of the same training initiative. Five overarching reasons for conducting pulse oximetry training were identified: 1) anaesthesia and perioperative care, 2) respiratory support programme expansion, 3) perinatal assessment and monitoring, 4) assessment and monitoring of children and 5) assessment and monitoring of adults. Educational programmes varied in their purpose with respect to the types of patients being targeted, the health care workers being instructed, and the depth of pulse oximetry specific training.
CONCLUSIONS
Pulse oximetry training initiatives have been ongoing for decades for a variety of purposes, utilising a multitude of approaches to equip health care workers with tools to improve patient care. It is important that these initiatives continue as pulse oximetry availability and knowledge gaps remain. Neither pulse oximetry provision nor training alone is enough to bolster patient care, but sustainable solutions for both must be considered to meet the needs of both health care workers and patients.
Topics: Adult; Child; Female; Pregnancy; Humans; Developing Countries; Pandemics; COVID-19; Educational Status; Health Personnel
PubMed: 37736848
DOI: 10.7189/jogh.13.04074 -
Archives of Disease in Childhood Aug 2016Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters... (Review)
Review
OBJECTIVE
Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used?
DESIGN
Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references.
PATIENTS
Children 0-19 years presenting for the first time to hospitals, emergency departments or primary care facilities.
INTERVENTIONS
Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used.
MAIN OUTCOME MEASURES
mortality, morbidity, length of stay, and treatment and management changes.
RESULTS
The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians' decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation.
CONCLUSIONS
As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes.
Topics: Adolescent; Child; Child, Preschool; Emergency Service, Hospital; Humans; Hypoxia; Infant; Infant, Newborn; Length of Stay; Oximetry; Primary Health Care; Treatment Outcome
PubMed: 26699537
DOI: 10.1136/archdischild-2015-309638 -
Pediatric Pulmonology Aug 2021To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes. (Review)
Review
OBJECTIVE
To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes.
METHODS
Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed.
RESULTS
A total of 24 studies including 1395 children were reviewed. Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children.
CONCLUSIONS
There exists large variability in pediatric decannulation protocols. Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.
Topics: Bronchoscopy; Child; Clinical Protocols; Device Removal; Humans; Polysomnography; Retrospective Studies; Tracheostomy
PubMed: 34231976
DOI: 10.1002/ppul.25503 -
Academic Emergency Medicine : Official... Aug 2016Tissue oximetry using near-infrared spectroscopy (NIRS) is a noninvasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (CA)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tissue oximetry using near-infrared spectroscopy (NIRS) is a noninvasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (CA) because of its ability to give measures in low-blood-flow situations. The aim of this study was to assess the evidence regarding the association between the types of NIRS measurements (mean, initial, and highest values) and resuscitation outcomes (return of spontaneous circulation [ROSC], survival to discharge, and good neurologic outcome) in patients undergoing cardiopulmonary resuscitation.
METHODS
This review was registered (Prospero CRD42015017380) and is reported as per the PRISMA guidelines. Medline, Embase, and CENTRAL were searched. All studies, except case reports and case series of fewer than five patients, reporting on adults that had NIRS monitoring during CA were eligible for inclusion. Two reviewers assessed the quality of the included articles and extracted the data. The outcome effect was standardized using standardized mean difference (SMD).
RESULTS
Twenty nonrandomized observational studies (15 articles and five conference abstracts) were included in this review, for a total of 2,436 patients. We found a stronger association between ROSC and mean NIRS values (SMD = 1.33; 95% confidence interval [CI] = 0.92 to 1.74) than between ROSC and initial NIRS measurements (SMD = 0.51; 95% CI = 0.23 to 0.78). There was too much heterogeneity among the highest NIRS measurements group to perform meta-analysis. Only two of the 75 patients who experienced ROSC had a mean NIRS saturation under 30%. Patients who survived to discharge and who had good neurologic outcome displayed superior combined initial and mean NIRS values than their counterparts (SMD = 1.63; 95% CI = 1.34 to 1.92; and SMD = 2.12; 95% CI = 1.14 to 3.10).
CONCLUSIONS
Patients with good resuscitation outcomes have significantly higher NIRS saturations during resuscitation than their counterparts. The types of NIRS measurements during resuscitation influenced the association between ROSC and NIRS saturation. Prolonged failure to obtain a NIRS saturation higher than 30% may be included in a multimodal approach to the decision of terminating resuscitation efforts (Class IIb, Level of Evidence C-Limited Data).
Topics: Adult; Cardiopulmonary Resuscitation; Female; Heart Arrest; Humans; Monitoring, Physiologic; Oximetry; Patient Discharge; Reference Standards; Spectroscopy, Near-Infrared
PubMed: 27028004
DOI: 10.1111/acem.12980 -
The Cochrane Database of Systematic... Nov 2016In patients of various ages undergoing mechanical ventilation (MV), it has been observed that positions other than the standard supine position, such as the prone... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In patients of various ages undergoing mechanical ventilation (MV), it has been observed that positions other than the standard supine position, such as the prone position, may improve respiratory parameters. The benefits of these positions have not been clearly defined for critically ill newborns receiving MV.This is an update of a review first published in 2005 and last updated in 2013.
OBJECTIVES
Primary objectiveTo assess the effects of different positioning of newborn infants receiving MV (supine vs prone, lateral decubitus or quarter turn from prone) in improving short-term respiratory outcomes. Secondary objectiveTo assess the effects of different positioning of newborn infants receiving MV on mortality and neuromotor and developmental outcomes over the long term, and on other complications of prematurity.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE via PubMed (1966 to 22 August 2016), Embase (1980 to 22 August 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 22 August 2016). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
SELECTION CRITERIA
Randomised and quasi-randomised clinical trials comparing different positions in newborns receiving mechanical ventilation.
DATA COLLECTION AND ANALYSIS
Three unblinded review authors independently assessed trials for inclusion in the review and extracted study data. We used standard methodological procedures as expected by The Cochrane Collaboration and assessed the quality of the evidence using the GRADE approach. If the meta-analysis was not appropriate owing to substantial clinical heterogeneity between trials, we presented review findings in narrative format.
MAIN RESULTS
We included in this review 19 trials involving 516 participants. Seven of the included studies (N = 222) had not been evaluated in the previous review. Investigators compared several positions: prone versus supine, prone alternant versus supine, prone versus lateral right, lateral right versus supine, lateral left versus supine, lateral alternant versus supine, lateral right versus lateral left, quarter turn from prone versus supine, quarter turn from prone versus prone and good lung dependent versus good lung uppermost.Apart from two studies that compared lateral alternant versus supine, one comparing lateral right versus supine and two comparing prone or prone alternant versus the supine position, all included studies had a cross-over design. In five studies, infants were ventilated with continuous positive airway pressure (CPAP); in the other studies, infants were treated with conventional ventilation (CV).Risks of bias did not differ substantially for different comparisons and outcomes. This update detects a moderate to high grade of inconsistency, similar to previous versions. However, for the analysed outcomes, the direction of effect was the same in all studies. Therefore, we consider that this inconsistency had little effect on the conclusions of the meta-analysis. When comparing prone versus supine position, we observed an increase in arterial oxygen tension (PO) in the prone position (mean difference (MD) 5.49 mmHg, 95% confidence interval (CI) 2.92 to 8.05 mmHg; three trials; 116 participants; I= 0). When percent haemoglobin oxygen saturation was measured with pulse oximetry (SpO), improvement in the prone position was between 1.13% and 3.24% (typical effect based on nine trials with 154 participants; I= 89%). The subgroup ventilated with CPAP (three trials; 59 participants) showed a trend towards improving SpO2 in the prone position compared with the supine position, although the mean difference (1.91%) was not significant (95% CI -1.14 to 4.97) and heterogeneity was extreme (I= 95%).Sensitivity analyses restricted to studies with low risk of selection bias showed homogeneous results and verified a small but significant effect (MD 0.64, 95% CI 0.26 to 1.02; four trials; 92 participants; I= 0).We also noted a slight improvement in the number of episodes of desaturation; it was not possible to establish whether this effect continued once the intervention was stopped. Investigators studied few adverse effects from the interventions in sufficient detail. Two studies analysed tracheal cultures of neonates after five days on MV, reporting lower bacterial colonisation in the alternating lateral position than in the supine posture. Other effects - positive or negative - cannot be excluded in light of the relatively small numbers of neonates studied.
AUTHORS' CONCLUSIONS
This update of our last review in 2013 supports previous conclusions. Evidence of low to moderate quality favours the prone position for slightly improved oxygenation in neonates undergoing mechanical ventilation. However, we found no evidence to suggest that particular body positions during mechanical ventilation of the neonate are effective in producing sustained and clinically relevant improvement.
Topics: Humans; Infant, Newborn; Oxygen; Patient Positioning; Prone Position; Randomized Controlled Trials as Topic; Respiration, Artificial; Supine Position
PubMed: 27819747
DOI: 10.1002/14651858.CD003668.pub4 -
PloS One 2015To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC).
DESIGN
Systematic review and meta-analysis.
STUDY SELECTION
Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC.
DATA SOURCES
Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015.
RISK OF BIAS ASSESSMENT
Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias.
RESULTS
Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude.
CONCLUSIONS
The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.
Topics: Developing Countries; Humans; Hypoxia; Respiratory Tract Infections; Risk Factors
PubMed: 26372640
DOI: 10.1371/journal.pone.0136166 -
BMC Pediatrics Oct 2023Bath is an external stimulus for preterm infants. Currently, three methods are used for preterm infants to bath. It is important to choose the best way for them. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Bath is an external stimulus for preterm infants. Currently, three methods are used for preterm infants to bath. It is important to choose the best way for them. The objective of this meta-analysis is to evaluate the effectiveness of different bath methods on physiological indexes and behavioral status of preterm infants.
METHODS
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO(CRD42022377657). PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Sino Med, China National Knowledge Internet (CNKI) and Wan-Fang database were systematically searched for randomized controlled trials on the effects of different bath methods for preterm infants. The retrieval time was from the establishment of the database to February 2023. According to the inclusion and exclusion criteria, the literature was screened, quality evaluated and the data was extracted. Reman Version 5.4 was used for meta-analysis and Stata 16.0 software for publication bias Egger's test.
RESULTS
A total of 11 RCTs with 828 preterm infants were included. The results of meta-analysis showed that the body temperature and oxygen saturation of preterm infants in the sponge bath group were lower than those in conventional tub bath group (SMD = -0.34; 95%CI -0.56 to -0.12; I = 0; p < 0.01), (MD = -0.39; 95%CI -0.76 to -0.02; I = 39%; p = 0.04), while the heart rates were higher than those in conventional tub bath group(MD = 5.90; 95%CI 0.44 to 11.35; I = 61%; p = 0.03). Preterm infant's body temperature and blood oxygen saturation of in swaddle bath group were higher than those in conventional tub bath group (MD = 0.18; 95%CI 0.05 to 0.30; I = 88%; p < 0.01), (MD = 1.11; 95%CI 0.07 to 2.16; I = 86%; p = 0.04), respiratory rates were more stable compared with infants in conventional tub bath group (MD = -2.73; 95%CI -3.43 to -2.03; I = 0; p < 0.01). The crying duration, stress and pain scores of preterm infants in swaddle bath group were lower than those in conventional tub bath group (SMD = -1.64; 95CI -2.47 to -0.82; I = 91%; p < 0.01), (SMD = -2.34; 95%CI -2.78 to -1.91; I = 0; p < 0.01), (SMD = -1.01; 95%CI -1.40 to -0.62; I = 49%; p < 0.01). Egger's test showed no publication bias in body temperature, respiratory rate, oxygen saturation, and crying duration.
CONCLUSIONS
Swaddle bath is the best bathing method than conventional tub bath and sponge bath in maintaining the stability of preterm infant's body temperature, blood oxygen saturation and respiratory rate. In addition, swaddle bath also plays a role in reducing cry duration, stress scores, and pain levels of preterm infant compared with conventional tub bath and sponge bath. However, due to the important heterogeneity in some outcomes, future studies with larger sample size and more appropriately design are needed to conduct before recommendation.
TRIAL REGISTRATION
Prospero CRD42022377657.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Body Temperature; Crying; Oximetry; Pain
PubMed: 37828460
DOI: 10.1186/s12887-023-04280-y -
Anesthesia and Analgesia Aug 2014Noninvasive hemoglobin (Hb) monitoring devices are available in the clinical setting, but their accuracy and precision against central laboratory Hb measurements have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Noninvasive hemoglobin (Hb) monitoring devices are available in the clinical setting, but their accuracy and precision against central laboratory Hb measurements have not been evaluated in a systematic review and meta-analysis.
METHODS
We conducted a comprehensive search of the literature (2005 to August 2013) with PubMed, Web of Science and the Cochrane Library, reviewed references of retrieved articles, and contacted manufactures to identify studies assessing the accuracy of noninvasive Hb monitoring against central laboratory Hb measurements. Two independent reviewers assessed the quality of studies using recommendations for reporting guidelines and quality criteria for method comparison studies. Pooled mean difference and standard deviation (SD) (95% limits of agreement) across studies were calculated using the random-effects model. Heterogeneity was assessed using the I statistic.
RESULTS
A total of 32 studies (4425 subjects, median sample size of 44, ranged from 10 to 569 patients per study) were included in this meta-analysis. The overall pooled random-effects mean difference (noninvasive-central laboratory) and SD were 0.10 ± 1.37 g/dL (-2.59 to 2.80 g/dL, I = 95.9% for mean difference and 95.0% for SD). In subgroup analysis, pooled mean difference and SD were 0.39 ± 1.32 g/dL (-2.21 to 2.98 g/dL, I = 93.0%, 71.4%) in 13 studies conducted in the perioperative setting and were -0.51 ± 1.59 g/dL (-3.63 to 2.62 g/dL, I = 83.7%, 96.4%) in 5 studies performed in the intensive care unit setting.
CONCLUSIONS
Although the mean difference between noninvasive Hb and central laboratory measurements was small, the wide limits of agreement mean clinicians should be cautious when making clinical decisions based on these devices.
Topics: Biomarkers; Hemoglobinometry; Hemoglobins; Humans; Monitoring, Physiologic; Observer Variation; Oximetry; Predictive Value of Tests; Reproducibility of Results; Spectrum Analysis
PubMed: 24914627
DOI: 10.1213/ANE.0000000000000272