Evaluation of the Masimo® Rainbow SET Radical-7 in a 6-month-old pediatric multivisceral organ transplant
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- Agrawal, A., Sullivan, J.N., Zink, M.A. et al. J Anesth (2012) 26: 629. doi:10.1007/s00540-012-1383-9
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KeywordsMulti-organ transplantPediatric transplantationLiverMasimo
Grams per deciliter
Pediatric Intensive Care Unit
Pleth Variability Index
Intraoperative hemoglobin lab measurements from blood gas analysis
To the Editor:
During multivisceral organ transplantation and isolated small bowel transplantation, patients often suffer large volume loss and expansion, wide fluctuations in red cell volume, and dilutional coagulopathy. Aggressive transfusion of blood products and isotonic fluids can lead to fluid overload, tissue and pulmonary edema, and inadequate perfusion, but failure to maintain intravascular volume can lead to hypotension and inadequate perfusion. The Pleth Variability Index (PVI) from the Masimo Rainbow SET Radical-7 gives us a noninvasive blood constituent monitoring platform that allows for the measurement of multiple blood constituents, fluid responsiveness, respiration rate, and other physiological parameters which previously required invasive blood sampling and time-consuming laboratory analysis . A rising PVI may indicate developing hypovolemia, and a falling PVI post fluid resuscitation is evidence of an appropriate fluid responsiveness, an important measure in the critical care/OR environment.
The Masimo Rainbow Set accurately measures transcutaneous hemoglobin measurements, which corresponded directly to the laboratory hemoglobin measurements. Side-by-side comparisons of the simultaneous measurements (tHb and SpHb) reveal hemoglobin accuracy within 1 g/dl of laboratory values, of which four were within less than 0.6 g/dl Hb value. There is no doubt that the Masimo Rainbow SET Radical-7 has the ability to perform well under physiologically unstable conditions; however, long wait-times for sensor calibration and recalibration are observed fairly frequently . This method of continuous noninvasive hemoglobin monitory can provide us with a valuable guidance to assessing blood loss and the need for transfusion therapy during surgery.
We thank Masimo Corporation for their administrative efforts.
Conflict of interest