J Clin Monit Comput - Evaluation of point-of-care analyzers' ability to reduce bias in conductivity-based hematocrit measurement during cardiopulmonary bypass.

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Resumo

Most point-of-care testing analyzers use the conductivity method to measure hematocrit (hct). During open-heart surgery, blood-conductivity is influenced by shifts in electrolyte and colloid concentrations caused by infusion media used, and this may lead to considerable bias in the hct measurement. We evaluated to what extent different analyzers correcting for 0, 1, 2, or 3 factors, respectively, compensated for this electrolyte/colloid interference: (1) the conductivity method with no correction (IRMA), (2) with a [Na(+)]-correction (GEM Premier 3000), (3) with a [Na(+)]/[K(+)]-correction (i-STAT), and (4) with a [Na(+)]/[K(+)]-correction in combination with an algorithm that estimates the protein dilution [i-STAT in cardiopulmonary bypass (CPB)-mode]. Bias in hct was measured during three consecutive stages of a CPB procedure: (I) before CPB, (II) start of CPB and (III) after cardioplegia. In order of high to low electrolyte/colloid interference: the analyzer with no correction, [Na(+)]-correction, [Na(+)/]/[K(+)]-correction, and [Na(+)/]/[K(+)]/estimated protein-correction showed a change of bias from stage I to stage III of -3.9 ? 0.5, -3.4 ? 0.4, -2.1 ? 0.5, -0.3 ? 0.5%. We conclude that correcting for more parameters (Na(+), K(+), estimated protein) gives less bias, but residual bias remains even after [Na(+)/]/[K(+)]/estimated protein-correction. This suggests that a satisfactory algorithm should also correct for other colloidal factors than protein.

Resumo Limpo

pointofcar test analyz use conduct method measur hematocrit hct openheart surgeri bloodconduct influenc shift electrolyt colloid concentr caus infus media use may lead consider bias hct measur evalu extent differ analyz correct factor respect compens electrolytecolloid interfer conduct method correct irma nacorrect gem premier nakcorrect istat nakcorrect combin algorithm estim protein dilut istat cardiopulmonari bypass cpbmode bias hct measur three consecut stage cpb procedur cpb ii start cpb iii cardioplegia order high low electrolytecolloid interfer analyz correct nacorrect nakcorrect nakestim proteincorrect show chang bias stage stage iii conclud correct paramet na k estim protein give less bias residu bias remain even nakestim proteincorrect suggest satisfactori algorithm also correct colloid factor protein

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