Detection of low-volume blood loss: compensatory reserve versus traditional vital signs.” The journal of trauma and acute care surgery

BACKGROUND: Humans are able to compensate for low-volume blood loss with minimal change in traditional vital signs.We hypothesized that a novel algorithm, which analyzes photoplethysmogram (PPG) wave forms to continuously estimate compensatory reserve would provide greater sensitivity and specificity to detect low-volume blood loss compared with traditional vital signs. The compensatory reserve index (CRI) is a measure of the reserve remaining to compensate for reduced central blood volume, where a CRI of 1 represents supine normovolemia and 0 represents the circulating blood volume at which hemodynamic decompensation occurs; values between 1 and 0 indicate the proportion of reserve remaining. METHODS: Subjects underwent voluntary donation of 1 U (approximately 450 mL) of blood. Demographic and continuous noninvasive vital sign wave form data were collected, including PPG, heart rate, systolic blood pressure, cardiac output, and stroke volume. PPG wave forms were later processed by the algorithm to estimate CRI values. RESULTS: Datawere collected from 244 healthy subjects (79 males and 165 females), with a mean (SD) age of 40.1 (14.2) years andmean (SD) body mass index of 25.6 (4.7). After blood donation, CRI significantly decreased in 92 % (> 0.05; 95 % confidence interval [CI], 88 95%) of the subjects. With the use of a threshold decrease in CRI of 0.05 or greater for the detection of 1 U of blood loss, the receiver operating characteristic area under the curve was 0.90, with a sensitivity of 0.84 and specificity of 0.86. In comparison, systolic blood pressure (52%; 95 % CI, 45 59%), heart rate (65%; 95 % CI, 58 72%), cardiac output (47%; 95 % CI, 40 54%), and stroke volume (74%; 95 % CI, 67 80%) changed in fewer subjects, had significantly lowe