Share
array:24 [ "pii" => "S2341192918300520" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.04.005" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "905" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:246-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935618300094" "issn" => "00349356" "doi" => "10.1016/j.redar.2018.01.005" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "905" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:246-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 170 "formatos" => array:2 [ "HTML" => 130 "PDF" => 40 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "¿Es fiable una muestra de gasometría para hemoglobinas en rango transfusional?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "246" "paginaFinal" => "251" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is a blood sample for hemoglobins in the transfusional range reliable?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1057 "Ancho" => 1383 "Tamanyo" => 112949 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Método de Bland y Altman para el hematocrito.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. López, L. Gómez, G. Petinal, N. Adán, S. Alvarado, N. Carballo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "López" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Gómez" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Petinal" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Adán" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Alvarado" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Carballo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918300520" "doi" => "10.1016/j.redare.2018.04.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300520?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300094?idApp=UINPBA00004N" "url" => "/00349356/0000006500000005/v1_201805080427/S0034935618300094/v1_201805080427/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918300556" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.04.008" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "913" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:252-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Correlation of preoperative findings in computed axial tomography with the presence of difficult airway in patients undergoing head and neck otorhinolaryngological surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "252" "paginaFinal" => "257" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Correlación de hallazgos preoperatorios en la tomografía axial computarizada con la presencia de vía aérea difícil en pacientes intervenidos mediante cirugía otorrinolaringológica de cabeza y cuello" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1544 "Ancho" => 1504 "Tamanyo" => 64291 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">COR curve of VC/PPW in Cormack III/IV patients.</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CV/PPW: distance from the vocal cords to the posterior pharyngeal wall. Area down the curve: 64.9%.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.C. Gutiérrez, S. Merino, P. de la Calle, C. Perrino, M. Represa, P. Moral" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.C." "apellidos" => "Gutiérrez" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Merino" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "de la Calle" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Perrino" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Represa" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Moral" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618300173" "doi" => "10.1016/j.redar.2018.01.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300173?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300556?idApp=UINPBA00004N" "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300556/v1_201805120427/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918300015" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.11.016" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "886" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:243-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 8 "formatos" => array:2 [ "HTML" => 7 "PDF" => 1 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Opioid free anesthesia with BIS/EMG monitored propofol-ketamine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "245" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Anestesia libre de opioides con propofol-ketamina monitorizada mediante BIS/EMG" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B.L. Friedberg" "autores" => array:1 [ 0 => array:2 [ "nombre" => "B.L." "apellidos" => "Friedberg" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617302700" "doi" => "10.1016/j.redar.2017.11.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302700?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300015?idApp=UINPBA00004N" "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300015/v1_201805120427/en/main.assets" ] "en" => array:22 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Is a blood sample for hemoglobins in the transfusional range reliable?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "246" "paginaFinal" => "251" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. López, L. Gómez, G. Petinal, N. Adán, S. Alvarado, N. Carballo" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "López" "email" => array:1 [ 0 => "angel.orense@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Gómez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Petinal" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "N." "apellidos" => "Adán" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Alvarado" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "N." "apellidos" => "Carballo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es fiable una muestra de gasometría para hemoglobinas en rango transfusional?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1373 "Ancho" => 1418 "Tamanyo" => 130505 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pearson linear regression between POC and central laboratory haemoglobin levels with 95% confidence interval for the mean and 95% individual confidence interval. Hb POC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.37<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>0.95<span class="elsevierStyleHsp" style=""></span>*<span class="elsevierStyleHsp" style=""></span>Hb.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">During a stay in the ICU, a patient will typically lose more than 700 ml of blood for lab tests alone.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> In a critically ill patient, frequent blood sampling for diagnostic purposes is essential, and up to 944 ml can be drawn.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> This is equivalent to losing 1 bag of packed red blood cells (PRBC) every 7–10 days. Arterial blood gas (ABG) testing is often performed to reduce blood loss and laboratory waiting times. This is a quick test that requires a smaller sample and shows the acid-base balance, haemoglobin (Hb) levels and electrolytes.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Validated ABG analysis techniques have been available for many years.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> However, Maslow et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> raised concerns about the important clinical differences and limitations found in the 3 point-of-care (POC) tests evaluated in their study, and warned clinicians not to rely on these data as sole determinants of when to perform transfusion. In critical care, the most frequent cause of transfusion (up to 72% of patient) is low Hb.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study has been to evaluate the correlation and concordance in our unit and patient population between Hb levels from a POC ABG device and from central laboratory tests (CLT), and to evaluate the extent to which sole reliance on POC Hb levels can lead to errors in administering or failing to administer blood transfusions.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Material and method</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective study in patients admitted to the surgical intensive care unit (SICU) of the University Hospital Complex of Ourense. The protocol (number 2016/371) was submitted to and approved by the Pontevedra-Vigo-Ourense Research Ethics Board.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients admitted to the SICU between 1 July 2015 and 15 November 2015 with at least 1 simultaneous POC ABG and CLT result were included in the study, in other words, patients from whom samples had been collected and tested simultaneously and recorded in a validated central laboratory report. Patients under 18 years of age, and any patients not meeting the inclusion criterion were excluded.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The following variables were collected: age, sex, reason for admission to the SICU, APACHE II score, Hb according to ABG, haematocrit (Hct) according to ABG, Hb according to CLT, Hct according to CLT, lactate, sodium, potassium, ordinary biochemical sodium, standard electrolyte panel (sodium and potassium), platelets, and leukocytes. All data were anonymised at the time of collection. All irrelevant information was removed from our records at the end of the study.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The primary outcome measures were Hb according to POC ABG testing and Hb according to conventional CLT. For this purpose, the results of the ABG test and CLT performed simultaneously were obtained from the final validated laboratory report. Blood samples drawn from patients were tested using the Siemens Rapidlab 1265 (Siemens Healthcare GmbH, Henkestr. 127, 91052 Erlangen, Germany) blood gas analyser and the WBC was performed using the Sysmex XN-1000 (Sysmex Corporation, 1-5-1 Wakinohama-kaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan) haematology analyser.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given that the aim of the study was to detect errors in respect of the total sample analysed, we decided to calculate the sample size on a proportional basis. Therefore, for a 95% confidence interval and a margin of error of 3%, 1,067 samples were necessary. Estimating 5% of losses in the preanalytical or analytical phase, the final number of samples needed for analysis was 1,123, which was our sample size. Statistical analysis was performed on SPSS 16 for Windows, MedCal 17.9 for Windows, LibreOffice 5.1 for Linux, Sofa Statistics 1.4.6 for Linux, and EpiDat 4.2.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Hb thresholds for transfusion were <span class="elsevierStyleMonospace"><</span>7, <span class="elsevierStyleMonospace"><</span>8, <span class="elsevierStyleMonospace"><</span>9 and <10 g/dl. These are the values established in the Seville Consensus Document,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> endorsed by the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Anaesthesiology, Critical Care and Pain Management(SEDAR), the Spanish Society of Haematology and Haemotherapy (SEHH), Blood Transfusion (SETS), Thrombosis and Haemostasis (SETH), and the Spanish Society of Hospital Pharmacy (SEFH). According to the GRADE<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> methodology, a strong recommendation implies in all cases that the benefits of the intervention clearly outweigh the risks and burdens (positive recommendation) or vice versa (negative recommendation). A 1 A recommendation is supported by high or moderate quality evidence and indicates that the intervention can apply to most patients in most circumstances without reservation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In critical, polytrauma and/or surgical patients, with no cardiological and/or central nervous system involvement, we recommend transfusion of PRBC to maintain Hb levels between 7 and 9<span class="elsevierStyleHsp" style=""></span>g/dl in order to reduce the transfusion rate. Recommendation 1 A.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In critical, polytrauma and/or surgical, with cardiological and/or central nervous system involvement, we recommend transfusion of PRBC to maintain Hb levels between 8 and 10<span class="elsevierStyleHsp" style=""></span>g/dl in order to reduce the transfusion rate. Recommendation 1 A.</p><p id="par0060" class="elsevierStylePara elsevierViewall">After collecting the data, we performed a preliminary analysis to identify errors that could distort the interpretation of the data. One such error involves drawing the blood in the vicinity of a venous infusion line, which would yield haemodiluted samples. To identify cases where this error occurred and eliminate the corresponding data, the low Hb and/or Hct data were compared with the platelet and leukocyte levels and electrolyte alterations (hypernatraemia, hypokalaemia) that are typical of blood samples contaminated with physiological serum.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the preanalytical stage, any samples recorded in the laboratory report as containing such errors, or considered inadequate, coagulated, too small, etc., were eliminated from the analysis.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Before performing the statistical analysis, the normal distribution of the sample was verified using normal probability plot.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Each Hb and Hct regression was tested using a multivariate analysis that included ABG Hb, ABG Hct, CLT Hb, CLT Hct, lactate, sodium, potassium, standard sodium, standard potassium, platelets and leukocytes. The secondary variables collected were eliminated because these parameters had little weight in the final formula and made no difference to the final results of the statistical analysis. For this reason, we performed a Pearson correlation analysis and a Passing-Bablok regression.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The degree of concordance between POC and CLT Hb levels was tested using the intraclass correlation coefficient, Lin's concordance correlation coefficient, and a Bland and Altman plot.</p><p id="par0085" class="elsevierStylePara elsevierViewall">To estimate the number of transfusion errors that would have been caused by over- or under-estimation of Hb if standard CLT tests had not also been used, each variable was entered in a 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2 contingency table contrasting ABG and CLT Hb levels. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of each Hb threshold.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In this study, we aimed not only to clarify the correlation and concordance between the 2 types of Hb measurement, but also to address more practical issues, such as the indication for transfusion according to the thresholds used in SICUs, and the likelihood of error when the indication for transfusion is based on ABG testing alone.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 1123 samples were collected, of which 39 were rejected due to sampling errors, bringing the final total to 1,084 valid samples. The study population consisted of 147 patients with a mean age of 69<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 years, with a male:female ratio of 97:50, a mean APACHE II score of 15.93<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.80, and an overall mortality rate of 21 patients; 23.8% were trauma patients. Mean POC Hb levels were 9.87<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.64, mean CLT levels were 10.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.09, mean POC Hct was 31.78<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.25, and mean CLT Hct was 29.28<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.00.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The linear correlation between Hb levels were compared using the Pearson correlation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), where the correlation between the 2 variables was statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace"><</span><span class="elsevierStyleHsp" style=""></span>0.001), with a Pearson r of 0.74, yielding an <span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span> (the square of the Pearson correlation coefficient) of 0.56. The validity of the regression model was verified by residual analysis. Passing-Bablok regression showed that the 2 study methods are not linear (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), with a Spearmann correlation coefficient of 0.76 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace"><</span><span class="elsevierStyleHsp" style=""></span>0.0001) and a POC Hb equation of −1.07<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>1.18 Hb. Hct levels were analysed in the same way (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), showing a high degree of statistical significance: <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace"><</span><span class="elsevierStyleHsp" style=""></span>0.001, <span class="elsevierStyleItalic">r</span> 0.72 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span> 0.51. The validity of the regression model was also verified by residual analysis. Passing-Bablok regression showed that the 2 study methods are not linear (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05), with a Spearmann correlation coefficient of 0.74 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace"><</span><span class="elsevierStyleHsp" style=""></span>0.0001) and a POC Hct equation of −3.6<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>1.19 Hct.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Concordance with Hb levels was moderate, with an intraclass correlation coefficient of 0.63 (0.60–0.67). Lin's correlation coefficient showed poor concordance (0.65<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.02).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> The Bland–Altman plot (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) showed that the POC test slightly overestimated Hb by 0.88 compared with the CLT, with a confidence interval that showed that the POC is between 3.62 above and 1.87 below.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Similar results were obtained for Hct, with an intraclass correlation coefficient of 0.62 (0.58–0.65), and moderate concordance. Lin's correlation coefficient showed poor concordance (0.63<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.02).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> The Bland–Altman plot (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) showed that the POC test slightly overestimated Hct by 2.50 compared with the CLT, with a confidence interval that showed that the POC is between 11.10 above and 6.10 below.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2 contingency table for each Hb and Hct threshold. Analysing the indication for transfusion based on a haemoglobin threshold of less than 7 g/dl with a confidence interval of 95%, showed a sensitivity (S) of 62.50% (25.89–89.75%), a specificity (Sp) of 98.88% (98.00–99.39%), a positive predictive value (PPV) of 29.41% (11.37–55.95%), and a negative predictive value (NPV) of 99.72% (99.10–99.92%). Similar data were obtained with a haemoglobin threshold of less than 8: S 33.75% (23.79–45.28%), Sp 97.51% (96.29–98.34%), PPV 51.92% (37.78–65.78%) and NPV 94.86% (93.28–96.09%). For a haemoglobin threshold of less than 9: S 44.41% (38.92–50.02%), Sp 95.28% (93.45–96.62%), PPV 79.89% (73.11–85.34%) and NPV 80.22% (77.44–82.73%); and for a threshold of 10: S 60.63% (56.78–64.35%), Sp 94.06% (91.24–96.04%), PPV 94.15% (91.36–96.09%) and NPV 60.27% (56.40–64.20%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">As part of our strategy to reduce the number of blood tests performed on patients in our unit, we set out to test our hypothesis that a simpler test that requires smaller samples, such as ABG POC testing, would compare favourably to CLT and would not affect transfusion errors. First, we wondered whether certain analytical parameters could influence the results of the POC test. On the basis of the test results obtained from our sample, we were able to rule out this risk. We then set out to determine the degree of correlation between POC and CLT. The coefficient of determination shows the percentage of variation explained by a model that may include several variables. In our study, only 51–56% of the samples matched real Hb or Hct values. These results are similar to those reported in other studies that warn against relying solely on POC determinations to decide whether transfusion is indicated.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,8</span></a> The lack of linearity obtained in the Passing-Bablok test showed that the POC ABG is unsuitable, and the values obtained from this test cannot be used to indicate the need for transfusion. The intraclass correlation coefficient, Lin's correlation concordance coefficient, and the Bland–Altman plot performed to test concordance clearly showed a low-to-moderate concordance between the 2 study methods.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The poor results obtained could be due to several factors. Obtaining data from procedures carried out in routine clinical practice increases the number of distorting factors: type of patient, sampling method, preparation and homogenisation of the samples, processing times, etc. However, in purely practical terms the results obtained in this context can help identify real-world errors. An analysis of the reasons leading to the low level of concordance is beyond the scope of this study.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Clinicians are well aware that the indication of transfusion should not be based solely on Hb levels. However, according to the Seville Consensus Document, the weight of this variable is greater in critically ill patients than in normal patients, due to their special characteristics.</p><p id="par0135" class="elsevierStylePara elsevierViewall">With respect to Hb in the transfusion range, our study shows that the Siemens Rapidlab 1265 tends to over- or under-estimate the need for transfusion based on the haemoglobin threshold, since the positive and negative predictive values vary according to the threshold used. This could lead clinicians to either withhold transfusion when it is needed, or administer un-needed blood products (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Based on our data, a POC Hb value of less than 7 would correspond to an Hb level of less 7 in CLT in only 29.41% of the patients in our sample. The likelihood of a correct indication for transfusion based on POC Hb levels increases in parallel with an increase in the transfusion threshold, while the likelihood of correctly withholding transfusion on the basis of POC Hb values decreases. Although predictive values can alter results according to the prevalence of the disease under study, we consider that the information obtained in this way is more visual and useful that that obtained using likelihood ratios.</p><p id="par0145" class="elsevierStylePara elsevierViewall">It would be interesting to determine why these differences arise and why predictive values are so low at critical Hb levels. In our hospital, POC is not available in the SICU, so Hb levels blood must be collected, prepared, and sent to the central laboratory through a pneumatic tube system, after which it is processed and tested and the results returned in a report. In addition, due to their special characteristics, the results obtained from intensive care patients may differ from those obtained from the general patient population. We do not know if any of these factors could improve the final results; this must be evaluated in another type of study.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In conclusion, we were unable to identify any variables that influence the correlation between POC and CLT measurement of haemoglobin or haematocrit levels. The degree of concordance or reliability between both measurement methods was moderate-low. There is a high probability that errors will be made in ordering or withholding transfusion when the decision is based on ABG Hb levels, particularly in the case of low transfusion thresholds.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1024752" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Results" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec982659" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1024751" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Resultados" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec982660" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack346135" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-09-12" "fechaAceptado" => "2018-01-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec982659" "palabras" => array:3 [ 0 => "Hematocrit" 1 => "Hemoglobin" 2 => "Point-of-care systems" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec982660" "palabras" => array:3 [ 0 => "Hematocrito" 1 => "Hemoglobina" 2 => "Sistemas point-of-care" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the correlation and agreement in our unit and population of hemoglobin in gasometry versus hematology analyzer, to evaluate errors in transfusion or lack thereof.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">strong association between Point-of-care (POC) and hematimetry, with <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001, with a coefficient of determination <span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span> of 0.56, an intraclass correlation coefficient of 0.63 and a Lin's concordance correlation coefficient of 0.65. For hemoglobins less than 7<span class="elsevierStyleHsp" style=""></span>g/dL, a success rate of 29.41% was obtained.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Low-moderate agreement of POC hemoglobin with standard haemothymetry. High probability of errors in the indication of transfusion based on gasometer hemoglobins, especially in low hemoglobins.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Results" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Objetivo</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Evaluar la correlación y la concordancia en nuestra unidad y en la población de la cifra de hemoglobina en gasometría versus hematimetría estándar; valorar errores en transfusión o falta de la misma.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fuerte asociación entre los resultados del gasómetro (POC) y la hematimetría, con p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001, con un coeficiente de determinación r<span class="elsevierStyleSup">2</span> de 0,56, un coeficiente de correlación intraclase de 0,63 y un coeficiente de correlación de Lin de 0,65. Valores similares para el hematocrito. Para hemoglobinas menores de 7<span class="elsevierStyleHsp" style=""></span>g/dl se obtiene una tasa de acierto del 29,41%.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Concordancia baja-moderada de la hemoglobina del POC con la hematimetría estándar. Alta probabilidad de errores en la indicación de transfusión en base a hemoglobinas de gasómetro, sobre todo en hemoglobinas bajas.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Resultados" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López A, Gómez L, Petinal G, Adán N, Alvarado S, Carballo N. ¿Es fiable una muestra de gasometría para hemoglobinas en rango transfusional? Rev Esp Anestesiol Reanim. 2018;65:246–251.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">África Morán Álvarez, Ana Gómez Pombo, Andrea Carballude García, Ángel López Pérez, Beatriz García Martín, Cristina Teresa de Llano Sánchez, Cristina Zepeda Blanco, Guillermo Petinal Algás, Jackeline Lucia Carrera Sieiro, Javier Juan Centeno García, Jorge do Olmo Rodríguez, Laura González Dacal, Laura Lamelas Rodríguez, Leticia Gómez Viana, Lucia Tojo Díaz, Luis Martín Muñoz, María Lage Rey, María Elena Paramés Mosquera, Marta Couñago Garrido, Milagros Cid Manzano, Nerea González Salas, Noelia Gago Dieguez, Nuria Adán Valencia, Nuria Carballo Loureiro, Olalla Figueiredo González, Pablo González Montes, Sara Pardo López, Sonia Alvarado de la Torre.</p>" "etiqueta" => "Annex" "titulo" => "Members of the Research Group in Anaesthesia and Critical Care, Institute of Health Research Galicia SUR (ISS Galicia Sur). SERGAS-UVIGO" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1373 "Ancho" => 1418 "Tamanyo" => 130505 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pearson linear regression between POC and central laboratory haemoglobin levels with 95% confidence interval for the mean and 95% individual confidence interval. Hb POC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.37<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>0.95<span class="elsevierStyleHsp" style=""></span>*<span class="elsevierStyleHsp" style=""></span>Hb.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1383 "Ancho" => 1425 "Tamanyo" => 138551 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Pearson linear regression between POC and central laboratory haematocrit levels with 95% confidence interval for the mean and 95% individual confidence interval. Hct POC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.56<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>0.90<span class="elsevierStyleHsp" style=""></span>*<span class="elsevierStyleHsp" style=""></span>Hb.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1057 "Ancho" => 1345 "Tamanyo" => 110373 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman plot of haemoglobin levels.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1057 "Ancho" => 1383 "Tamanyo" => 111522 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman plot of haematocrit levels.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1152 "Ancho" => 2167 "Tamanyo" => 78493 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Positive and negative predictive values according to transfusion threshold.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hb POC/central laboratory test \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><7 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><8 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><9 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><10 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">≥10 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">143 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">170 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">259 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">402 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">≥10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">261 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">396 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1742335.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Haemoglobin and haematocrit levels according to testing method and threshold.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phlebotomy for diagnostic laboratory test in adults: pattern of use and effect on transfusion requirements" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.R. Smoller" 1 => "M.S. Kruskall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198605083141906" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1986" "volumen" => "314" "paginaInicial" => "1233" "paginaFinal" => "1235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3702919" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Precision and accuracy of the immediate determination of hemoglobin using HemoCueB hemoglobin in urgent, surgical, and critical patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Muñoz Gómez" 1 => "E. Naveira Abeigón" 2 => "A. Romero Ruiz" 3 => "G. Ramírez Ramírez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2003" "volumen" => "50" "paginaInicial" => "332" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14552105" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care hemoglobin/hematocrit testing: comparison of methodology and technology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Maslow" 1 => "A. Bert" 2 => "A. Singh" 3 => "J. Sweeney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2015.11.010" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "352" "paginaFinal" => "362" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27013121" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood component use in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.P. Rao" 1 => "H. Boralessa" 2 => "C. Morgan" 3 => "N. Soni" 4 => "D.R. Goldhill" 5 => "S.J. Brett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "530" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12010265" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.R. Leal-Noval" 1 => "M. Muñoz" 2 => "M. Asuero" 3 => "E. Contreras" 4 => "J.A. García-Erce" 5 => "J.V. Llau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2012.12.003" "Revista" => array:5 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2013" "volumen" => "60" "paginaInicial" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23415109" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sistema GRADE: metodología para la realización de recomendaciones para la práctica clínica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Sanabria" 1 => "D. Rigau" 2 => "R. Rotaeche" 3 => "A. Selva" 4 => "M. Marzo-Castillejo" 5 => "P. Alonso-Coello" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aprim.2013.12.013" "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "2015" "volumen" => "47" "paginaInicial" => "48" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24684818" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cómo interpretar los “Niveles de Evidencia” en los diferentes escenarios clínicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Manterola" 1 => "D. Zavando" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Chil Cir" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "582" "paginaFinal" => "595" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Allardet-Servent" 1 => "M. Lebsir" 2 => "C. Dubroca" 3 => "M. Fabrigoule" 4 => "S. Jordana" 5 => "T. Signouret" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0169593" "Revista" => array:7 [ "titulo" => "Point-of-care versus central laboratory measurements of hemoglobin, hematocrit, glucose bicarbonate and electrolytes: a prospective observational study in critically ill patients" "tituloSerie" => "PLoS ONE" "fecha" => "2017" "volumen" => "12" "paginaInicial" => "e0169593" "editores" => "Y.Cai" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28072822" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "HAM2005-062" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A proposal for strength-of-agreement criteria for Lin's concordance correlation coefficient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.B. McBride" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2005" "editorial" => "NIWA Client Report" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack346135" "titulo" => "Acknowledgements" "texto" => "<p id="par0160" class="elsevierStylePara elsevierViewall">We would like to thank the members of the <span class="elsevierStyleItalic">Grupo de Investigación en Anestesia y Cuidados Críticos</span> for their help with this project.</p> <p id="par0165" class="elsevierStylePara elsevierViewall">Our thanks also go to:</p> <p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Delfina Suárez Vázquez</span>: Head of the Clinical Analysis Unit Ourense University Hospital Complexo.</p> <p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Gabriel Jaime Sánchez</span>: Head of the Clinical Analysis Department, Ourense University Hospital Complexo.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300520/v1_201805120427/en/main.assets" "Apartado" => array:4 [ "identificador" => "34051" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000005/v1_201805120427/S2341192918300520/v1_201805120427/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300520?idApp=UINPBA00004N" ]
