title: Real-time evaluation of an image analysis system for monitoring surgical hemoglobin loss.
abstract: Monitoring blood loss is important for management of surgical patients. This study reviews a device (Triton) that uses computer analysis of a photograph to estimate hemoglobin (Hb) mass present on surgical sponges. The device essentially does what a clinician does when trying to make a visual estimation of blood loss by looking at a sponge, albeit with less subjective variation. The performance of the Triton system is reported upon in during real-time use in surgical procedures. The cumulative Hb losses estimated using the Triton system for 50 enrolled patients were compared with reference Hb measurements during the first quarter, half, three-quarters and full duration of the surgery. Additionally, the estimated blood loss (EBL) was calculated using the Triton measured Hb loss and compared with values obtained from both visual estimation and gravimetric measurements. Hb loss measured by Triton correlated with the reference method across the four measurement intervals. Bias remained low and increased from 0.1 g in the first quarter to 3.7 g at case completion. The limits of agreement remained narrow and increased proportionally from the beginning to the end of the cases, reaching a maximum range of -15.3 to 22.7 g. The median (IQR) difference of EBL derived from the Triton system, gravimetric method and visual estimation versus the reference value were 13 (74), 389 (287), and 4 (230) mL, respectively. Use of the Triton system to measure Hb loss in real-time during surgery is feasible and accurate.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Gerhardt
authors.initials: G
authors.lastname: Konig
authors.affiliation: Departments of Anesthesiology and Bioengineering, University of Pittsburgh School of Medicine, and McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
authors.affiliation: Englewood Hospital and Medical Center, Englewood, NJ, USA.
authors.forename: Mazyar
authors.initials: M
authors.lastname: Javidroozi
authors.affiliation: Department of Anesthesiology, Santa Clara Valley Medical Center, San Jose, CA, USA.
authors.forename: Bridget
authors.initials: B
authors.lastname: Philip
authors.affiliation: Department of Obstetrics, Santa Clara Valley Medical Center, San Jose, CA, USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Ting
authors.affiliation: Department of Orthopedics, Santa Clara Valley Medical Center, San Jose, CA, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Abbi
authors.affiliation: Gauss Surgical, Inc., Los Altos, CA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Hsieh
authors.affiliation: Gauss Surgical, Inc., Los Altos, CA, USA. griff.tully@gausssurgical.com.
authors.forename: Griffeth
authors.identifier: http://orcid.org/0000-0003-4691-0731
authors.initials: G
authors.lastname: Tully
authors.affiliation: Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA.
authors.forename: Gregg
authors.initials: G
authors.lastname: Adams
mesh_terms: D000328:Adult; D000465:Algorithms; D016063:Blood Loss, Surgical; D003627:Data Interpretation, Statistical; D006452:Hemoglobinometry / Q000295:instrumentation*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012984:Software; D013514:Surgical Procedures, Operative; D015503:Surgical Sponges
chemical_list: D006454:Hemoglobins
keywords: Gravimetric method; Hemoglobin loss; Intraoperative blood loss; Sponge blood estimation