2018, Number 2
Rev Mex Anest 2018; 41 (2)
Concordance between a determined blood volume and its visual estimation by anaesthesiologists at the Hospital Central Militar
Martínez-Ramírez JS, Estrada-Ramos FS, Monciváis-Vázquez NN
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In surgery, intraoperative bleeding allows complications predicting, it guides management to be followed by the anesthesiologist. The most commonly used method is the visual estimation, despite its imprecision and may over or underestimate blood loss, it becomes an intraoperative challenge treatment.
Material and methods:
Observational clinical study to determine the correlation between visual estimate of bleeding and actual volumes of blood, using a simulated scenario with absorbent material (gauze pad and bottles collectors). 30 Central Military Hospital Anesthesiology physicians and 18 residents participated, estimating the volume in milliliters of blood impregnated in each material. The intraclass correlation coefficient was used to estimate the agreement and to identify predictors of agreement between visual estimation and actual value, a logistic regression analysis.
Overestimation in 59.8% of estimates. Logistic regression analysis identified the years of experience of the anesthetist (OR 0.286, 95% CI: 0.653 - 1.0; p = 0.007) as the sole predictor of agreement between estimated and actual value.
The visual estimate by the Central Military Hospital anesthesiologists had a poor match with the actual amount of fresh whole blood impregnated in various materials.
Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139-144.
Gibbon E, Courpied JP, Hamadouche M. Total joint replacement and blood loss: what is the best equation? Int Orthop. 2013;37:735-739.
Bhil F. Castelli D, Marincola F,Dodd RY, Brander C. Transfusion-transmitted infections. J Transl Med. 2007;5:25.
Mercuriali F, Inghilleri G. Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin. 1996;13:465-478.
Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224-232.
Lee MH, Ingvertsen BT, Kirpensteign J, Jensen AL, Kristensen AT. Quantification of surgical blood loss. Vet Surg. 2006;35:388-393.
Gahres EE, Albert SN, Dodek SM. Intrapartum blood loss measured with Cr 51-tagged erythrocytes. Obstet Gynecol. 1962;19:455-462.
Duthie SJ, Ven D, Yung GL, Guang DZ, Chan SY, Ma HK. Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery. Eur J Obstet Gynecol Reprod Biol. 1991;38:119-124.
Gatthas PJ. Objective measures for estimating intraoperative blood loss. Wellmont Orthopedic Residency Program. University of Texas Health Science Center; 2015.
Rubio-Romero JA, Guevara-Cruz OA, Gaitán-Duarte H. Validez de la estimación visual como método diagnóstico de la hemorragia postparto severa en un hospital universitario. Rev Fac Med. 2010;58:173-184.
Kolb KS, Day T, McCall WG. Accuracy of blood loss determination by health care professionals. CRNA. 1999;10:170-173.
Prasertcharoensuk W, Swadpanich U, Lumbiganon P. Accuracy of the blood loss estimation in the third stage of labor. Int J Gynecol Obstet. 2000;71:69-70.
Brant HA. Precise estimation of postpartum hemorrhage: difficulties and importance. Br Med J. 1967;1:398-400.
Larsson C, Salted S, Wilkund I, Pahlen S, Andolf E. Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstet Gynecol Scand. 2006;85:1448-1452.
Higgins PG. Measuring nurses’ accuracy of estimating blood loss. J Adv Nurs. 1982;7:157-162.
Kavle JA, Khalfan SS, Stoltzfus RJ, Witter F, Tielsch JM, Caulfield LE. Measurement of blood loss at childbirth and postpartum. Int J Gynecol Obstet. 2006;95:24-28.
Budny PG, Regan PJ, Roberts AH. The estimation of blood loss during burns surgery. Burns. 1993;19:134-137.
Sukprasert M, Choktanasiri W, Ayudhya NI, Promsonthi P, O-Prasertsawat P. Increase accuracy of visual estimation of blood loss from education program. J Med Assoc Thai. 2006;89:S54-59.
Maslovitz S, Barkai G, Lessing JB, Ziv A, Many A. Improved accuracy of postpartum blood loss estimation as assessed by simulation. Acta Obstet Gynecol Scand. 2008;87:929-934.
Moscati R, Billittier AJ, Marshall B, Fincher M, Jehle D, Braen GR. Blood loss estimation by out-of-hospital emergency care providers. Prehosp Emerg Care. 1999;3:239-242.
Martel MJ, Saskatoon SK. Hemorrhagic shock. J Obstet Gynecol Can. 2002;24:504-511.
Al Kadri HM, Al Anazi BK, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet. 2011;283:1207-1213.
Al-Kadri HM, Dahlawi H, Al Airan M, Elsherif E, Tawfeeq N, Mokhele Y, et al. Effect of education and clinical assessment on the accuracy of postpartum blood loss estimation. BMC Pregnancy and Childbirth. 2014;14:110.