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- W2950295258 abstract "We agree with Kalmar et al.1 that the noninvasive hemoglobin determination (SpHb) generated by the device may not be precise enough for single hemoglobin values as compared with those obtained using invasive measures. However, because trends are of interest when focusing on volume kinetic models, our conclusion was that the SpHb device could be useful for this purpose.2 We also agree with Kalmar et al.1 that the baseline Hb measurement is of interest and that minor and major shifts in the baseline do occur. One area of interest is to better understand changes in the perfusion index. Following is a brief description of how we view the physiological issues and challenges ahead. The SpHb measured by the Radical-7 device is based on multi-wavelength light absorption of hemoglobin in capillaries under the nail. The deviation of SpHb from arterial Hb is therefore multifactorial and depends on the Fåhreus effect, transcapillary fluid filtration absorption ratio, vasomotor tone (reflected by the perfusion index), and ambient temperature. The difference between arterial Hb and Hb in larger capillaries is relatively stable since it depends solely on the Fåhreus effect. However, this difference in the smallest capillaries is dynamic since it depends on the transcapillary fluid filtration absorption ratio, which in turn is affected by multiple factors, for example, changes in interstitial fluid compliance and net transcapillary pressure (the sum of hydrostatic and oncotic pressure gradients). Therefore, unpredictably, the SpHb may under- or overestimate arterial Hb, and ideally, this can be considered in future versions of the device. In summary, in our study, we were aware of the differences cited by Kalmar et al. but wanted to determine whether trend values generated by the noninvasive device could be used for volume kinetic analysis. Our conclusion was that, in the particular setting presented, the technology was helpful. Fredrik Sjöstrand, MD, PhD Department of Clinical Science & Education Section of Emergency Medicine Karolinska Institutet Department of Emergency Medicine Södersjukhuset AB Stockholm, Sweden [email protected] Christer Svensen, MD, PhD Department of Clinical Science & Education Section of Anesthesiology and Intensive Care Karolinska Institutet Södersjukhuset Stockholm, Sweden" @default.
- W2950295258 created "2019-06-27" @default.
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- W2950295258 date "2014-02-01" @default.
- W2950295258 modified "2023-10-18" @default.
- W2950295258 title "In Response" @default.
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- W2950295258 doi "https://doi.org/10.1213/ane.0000000000000034" @default.
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