Effect of Postural Change on Hemoglobin Level in Patients on the Intensive Care Unit
Trial Snapshot
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Deventer Ziekenhuis
- Enrollment
- 24
- Locations
- 1
- Primary Endpoint
- Hemoglobin
Study Overview
Brief Summary
Monitoring hemoglobin levels (Hb) is important to identify anemia in hospitalized patients. Changes in posture and mobilization efforts, as demonstrated by previous research, can lead to significant shifts in Hb concentrations. This phenomenon has not been studied in ICU patients.
This study aims to investigate whether postural changes and mobilisation affect Hb in ICU patients. We hypothesize that significant Hb shifts may occur, potentially leading to misinterpretations of anemia and unnecessary diagnostic and therapeutic workup. Understanding this impact can guide clinical practice and prevent unwarranted interventions.
Detailed Description
Rationale:
Monitoring hemoglobin levels (Hb) is important to identify anemia in hospitalized patients. Changes in posture and mobilization efforts, as demonstrated by previous research, can lead to significant shifts in Hb concentrations. Low Hb levels due to these shifts are termed 'postural pseudoanemia'.
This phenomenon has not been studied in ICU patients. Many factors may affect Hb concentrations in ICU patients, including plasma volume shifts, bleeding, repeated phlebotomies, hemolysis, bone marrow suppression and functional iron deficiency. When this leads to significant anemia, patients may be treated with red blood cell transfusions. However, blood transfusions have been associated with adverse reactions and should only be performed for appropriate indications. If postural pseudoanemia occurs in ICU patients this could lead to patient harm through inadvertent investigations and red blood cell transfusions. The occurrence of postural pseudoanemia in ICU patients may differ from previous studies because ICU patients are more frequently immobilized for more prolonged periods.
This study aims to investigate whether postural changes affect Hb in ICU patients. We hypothesize that significant Hb shifts may occur, potentially leading to misinterpretations of anemia and unnecessary diagnostic and therapeutic workup. Understanding this impact can guide clinical practice and prevent unwarranted interventions.
Objective:
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Sequential
- Primary Purpose
- Diagnostic
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age over 18 years, of any gender and ethnic background
- •Admitted to the intensive care unit
- •Able to give informed consent
- •Patients with an arterial line as part of their treatment plan.
- •Patients able to remain seated in chair for at least 30 minutes
- •Patients able to remain supine overnight for at least 6 hours
Exclusion Criteria
- •Delirium or inability to give informed consent
- •Inability to understand written information in Dutch
- •Patients on artificial ventilation
- •Orotracheally intubated patients (spontaneous breathing through a tracheostomy cannula is allowed)
- •Patients treated with noradrenaline > 0.05 ug/kg/min
- •Patients treated with argipressin
- •Patients who received a blood transfusion within 24 hours before measurements
- •Patients who received > 3 L of fluids within 24 hours before measurements
- •Patients who received > 500 ml of iv fluids within 4 hours of measurements
- •Severe restlessness or inability to remain supine for 6 hours before initial blood sampling
- •Patients being treated with diuretics
- •Patients admitted with:
- •Decompensated right heart failure
- •Pulmonary hypertension
- •Pulmonary embolism
- •Active bleeding or risk of >100 ml blood loss
- •Hematological disorder/malignancy
Arms & Interventions
Hb in different positions
Hemoglobin concentration after sitting in bed (passively) for >30 min, and after mobilization to a chair for >30 min
Intervention: Postural change from supine to sitting (Procedure)
Hb in different positions
Hemoglobin concentration after sitting in bed (passively) for >30 min, and after mobilization to a chair for >30 min
Intervention: Mobilization to a chair (Procedure)
Outcomes
Primary Outcomes
Hemoglobin
Time Frame: 3 hours
Hemoglobin concentration
Secondary Outcomes
- Albumin(3 hours)