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Journal of Clinical Monitoring and Computing

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Open Access 01-02-2015 | Original Research

Pulse oximetry-derived respiratory rate in general care floor patients

Authors: Paul S. Addison, James N. Watson, Michael L. Mestek, James P. Ochs, Alberto A. Uribe, Sergio D. Bergese

Published in: Journal of Clinical Monitoring and Computing | Issue 1/2015

Abstract

Respiratory rate is recognized as a clinically important parameter for monitoring respiratory status on the general care floor (GCF). Currently, intermittent manual assessment of respiratory rate is the standard of care on the GCF. This technique has several clinically-relevant shortcomings, including the following: (1) it is not a continuous measurement, (2) it is prone to observer error, and (3) it is inefficient for the clinical staff. We report here on an algorithm designed to meet clinical needs by providing respiratory rate through a standard pulse oximeter. Finger photoplethysmograms were collected from a cohort of 63 GCF patients monitored during free breathing over a 25-min period. These were processed using a novel in-house algorithm based on continuous wavelet-transform technology within an infrastructure incorporating confidence-based averaging and logical decision-making processes. The computed oximeter respiratory rates (RR_oxi) were compared to an end-tidal CO₂ reference rate (RR_ETCO2). RR_ETCO2 ranged from a lowest recorded value of 4.7 breaths per minute (brpm) to a highest value of 32.0 brpm. The mean respiratory rate was 16.3 brpm with standard deviation of 4.7 brpm. Excellent agreement was found between RR_oxi and RR_ETCO2, with a mean difference of −0.48 brpm and standard deviation of 1.77 brpm. These data demonstrate that our novel respiratory rate algorithm is a potentially viable method of monitoring respiratory rate in GCF patients. This technology provides the means to facilitate continuous monitoring of respiratory rate, coupled with arterial oxygen saturation and pulse rate, using a single non-invasive sensor in low acuity settings.

Addison PS. The illustrated wavelet transform handbook. New York: Taylor & Francis; 2002.CrossRef

Addison PS, Watson JN, Mestek ML, Mecca RS. Developing an algorithm for pulse oximetry derived respiratory rate (RRoxi): a healthy volunteer study. J Clin Monit Comput. 2012;26:45–51.PubMedCentralPubMedCrossRef

Bowker L, Stewart K. Predicting unsuccessful cardiopulmonary resuscitation (CPR): a comparison of three morbidity scores. Resuscitation. 1999;40:89–95.PubMedCrossRef

Chen J, Hillman K, Bellomo R, Flabouris A, Finfer S, Cretikos M. The impact of introducing medical emergency team system on the documentations of vital signs. Resuscitation. 2009;80:35–43.PubMedCrossRef

Dahan A, Aarts L, Smith TW. Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology. 2010;112:226–38.PubMedCrossRef

Folke M, Cernerud L, Ekstrom M, Hok B. Critical review of non-invasive respiratory monitoring in medical care. Med Biol Eng Comput. 2003;41:377–83.PubMedCrossRef

Green SM, Pershad J. Should capnographic monitoring be standard practice during emergency department procedural sedation and analgesia? Pro and con. Ann Emerg Med. 2010;55:265–7.PubMedCrossRef

Hillman KM, Bristow PJ, Chey T. Antecedents to hospital deaths. Intern Med J. 2001;31:343–8.PubMedCrossRef

Hodgetts TJ, Kenward G, Vlackonikolis I. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54:115–23.PubMedCrossRef

10.

Leonard P, Beattie TF, Addison PS, Watson JN. Standard pulse oximeters can be used to monitor respiratory rate. Emerg Med J. 2003;20:524–5.PubMedCentralPubMedCrossRef

11.

Leonard PA, Clifton D, Addison PS, Watson JN, Beattie T. An automated algorithm for determining respiratory rate by photoplethysmogram in children. Acta Paediatr. 2006;95:1124–8.PubMedCrossRef

12.

Leonard PA, Douglas JG, Grubb NR, Clifton D, Addison PS, Watson JN. A fully automated algorithm for the determination of respiratory rate from the photoplethysmogram. J Clin Monit Comput. 2006;20:33–6.PubMedCrossRef

13.

Dash S, Shelley KH, Silverman DG, Chon KH. Estimation of respiratory rate from ECG, photoplethysmogram, and piezoelectric pulse transducer signals: a comparative study of time-frequency methods. IEEE Trans Biomed Eng. 2010;57:1099–107.PubMedCrossRef

14.

Leuvan CH, Mitchell I. Missed opportunities? An observational study of vital sign measurements. Crit Care Resusc. 2008;10:111–5.PubMed

15.

Lindberg LG, Ugnell H, Oberg PA. Monitoring of respiratory and heart rates using a fibre-optic sensor. Med Biol Eng Comput. 1992;30:533–7.PubMedCrossRef

16.

Nilsson L, Johansson A, Kalman S. Macrocirculation is not the sole determinant of respiratory induced variations in the reflection mode photoplethysmographic signal. Physiol Meas. 2003;24:925–37.PubMedCrossRef

17.

Lazaro J, Gil E, Bailon R, Minchole A, Laguna P. Deriving respiration from photoplethysmographic pulse width. Med Biol Eng Comput. 2013;51:233–42.PubMedCrossRef

18.

Karlen W, Raman S, Ansermino JM, Dumont GA. Multiparameter respiratory rate estimation from the photoplethysmogram. IEEE Trans Biomed Eng. 2013;60:1946–53.PubMedCrossRef

19.

Pasero C, McCaffery M. Pain assessment and pharmacologic management. St Louis Mo: Elsevier/Mosby; 2011.

20.

Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98:1388–92.PubMedCrossRef

21.

Chon KH, Dash S, Ju K. Estimation of respiratory rate from photoplethysmogram data using time-frequency spectral estimation. IEEE Trans Biomed Eng. 2009;56:2054–63.PubMedCrossRef

22.

Clifton D, Douglas JG, Addison PS, Watson JN. Measurement of respiratory rate from the photoplethysmogram in chest clinic patients. J Clin Monit Comput. 2007;21:55–61.PubMedCrossRef

23.

Fleming S, Tarassenko L, Thompson M, Mant D. Non-invasive measurement of respiratory rate in children using the photoplethysmogram. Conf Proc IEEE Eng Med Biol Soc. 2008; 1886–1889.

24.

Fleming SG, Tarassenko L. A comparison of signal processing techniques for the extraction of breathing rate from the photoplethysmogram. Intern J Biol Med Sci. 2007;2:232–6.

25.

Foo JY, Wilson SJ. Estimation of breathing interval from the photoplethysmographic signals in children. Physiol Meas. 2005;26:1049–58.PubMedCrossRef

26.

Johansson A. Neural network for photoplethysmographic respiratory rate monitoring. Med Biol Eng Comput. 2003;41:242–8.PubMedCrossRef

27.

Johansson A, Oberg PA, Sedin G. Monitoring of heart and respiratory rates in newborn infants using a new photoplethysmographic technique. J Clin Monit Comput. 1999;15:461–7.PubMedCrossRef

28.

Johnston WS, Mendelson Y. Extracting breathing rate information from a wearable reflectance pulse oximeter sensor. Conf Proc IEEE Eng Med Biol Soc. 2004;7:5388–91.PubMed

29.

Lee J, Chon KH. Respiratory rate extraction via an autoregressive model using the optimal parameter search criterion. Ann Biomed Eng. 2010;38:3218–25.PubMedCrossRef

30.

Leonard P, Grubb NR, Addison PS, Clifton D, Watson JN. An algorithm for the detection of individual breaths from the pulse oximeter waveform. J Clin Monit Comput. 2004;18:309–12.PubMedCrossRef

31.

Nilsson L, Johansson A, Kalman S. Monitoring of respiratory rate in postoperative care using a new photoplethysmographic technique. J Clin Monit Comput. 2000;16:309–15.PubMedCrossRef

32.

Nilsson L, Johansson A, Kalman S. Respiration can be monitored by photoplethysmography with high sensitivity and specificity regardless of anaesthesia and ventilatory mode. Acta Anaesthesiol Scand. 2005;49:1157–62.PubMedCrossRef

33.

Olsson E, Ugnell H, Oberg PA, Sedin G. Photoplethysmography for simultaneous recording of heart and respiratory rates in newborn infants. Acta Paediatr. 2000;89:853–61.PubMedCrossRef

34.

Shelley KH, Awad AA, Stout RG, Silverman DG. The use of joint time frequency analysis to quantify the effect of ventilation on the pulse oximeter waveform. J Clin Monit Comput. 2006;20:81–7.PubMedCrossRef

35.

Wertheim D, Olden C, Savage E, Seddon P. Extracting respiratory data from pulse oximeter plethysmogram traces in newborn infants. Arch Dis Child Fetal Neonatal Ed. 2009;94:F301–3.PubMedCrossRef

36.

Zhou Y, Zheng Y, Wang C, Yuan J. Extraction of respiratory activity from photoplethysmographic signals based on an independent component analysis technique: Preliminary report. Instrum Sci Technol. 2006;34:537–45.CrossRef

37.

Alian AA, Shelley KH. Respiratory Physiology and the impact of different modes of ventilation on the photoplethysmographic waveform. 2012;2236–2254.

38.

Allen J, Frame JR, Murray A. Microvascular blood flow and skin temperature changes in the fingers following a deep inspiratory gasp. Physiol Meas. 2002;23(2):365–73.PubMedCrossRef

39.

Delerme S, Renault R, Le Mannach Y, Lvovschi V, Bendahou M, Riou B, Ray P. Variations of pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers. Am J Emerg Med. 2007;25:637–42.PubMedCrossRef

40.

Hamunen K, Kontinen V, Hakala E, Talke P, Paloheimo M, Kalso E. Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers. Br J Anaesth. 2012;108(5):838–44.PubMedCrossRef

41.

Knorr-Chung BR, McGrath SP, Blike GT. Identifying airway obstructions using photoplethysmography (PPG). J Clin Monit Comput. 2008;22(2):95–101.PubMedCrossRef

42.

Reisner A, Shaltis PA, McCombie D, Asada HH. Utility of the photoplethysmogram in circulatory monitoring. Anesthesiology. 2008;108(5):950–8.PubMedCrossRef

43.

Selvaraj N, Jaryal AK, Santhosh J, Deepak KK, Anand S. Influence of respiratory rate on the variability of blood volume pulse characteristics. J Med Eng Technol. 2009;33(5):370–5.PubMedCrossRef

44.

Shah A, Shelley KH. Is pulse oximetry an essential tool or just another distraction? The role of the pulse oximeter in modern anesthesia care. J Clin Monit Comput. 2013;27:235–42.PubMedCrossRef

45.

Shelley KH. Photoplethysmography: beyond the calculation of arterial oxygen saturation and heart rate. Anesth Analg. 2007;105(6 Suppl):S31–6.PubMedCrossRef

46.

ECRI Institute. Top 10 Health Technology Hazards For 2014. Adapted from: Health Devices. ECRI Institute, Plymouth Meeting, PA. 2013;42(11).

47.

Meredith DJ, Clifton D, Charlton P, Brooks J, Pugh CW, Tarassenko L. Photoplethysmographic determination of respiratory rate: a review of current literature. J Med Eng Technol. 2013;36:1–7.CrossRef

48.

Addison PS, Watson JN. Wavelet-based analysis of pulse oximeter signals. US Patent 7,035,679. 2006.

49.

Addison PS, Watson JN, Clifton D. Methods and systems for discriminating bands in scalograms. US Patent 8,077,297. 2011.

50.

Watson JN, Addison PS. Methods and systems for filtering a signal according to a signal model and continuous wavelet transform techniques. US Patent 8,235,911. 2012.

51.

Watson JN, Addison PS, Clifton D. Systems and methods for ridge selection in scalograms. US Patent 8,295,567. 2012.

52.

Watson JN, Addison PS, Van Slyke BM. Systems and methods for estimating values of a continuous wavelet transform. US Patent 8,346,333. 2013.

53.

McGonigle S, Addison PS, Ochs J, Watson JN. Systems and methods for determining respiration information from a photoplethysmograph. US Patent Application 20130079606. 2013.

54.

ISO 80601-2-61:2011. Medical electrical equipment—Part 2-61: particular requirements for basic safety and essential performance of pulse oximeter equipment. International Organization for Standardization, 2011.

55.

Mestek ML, Ochs JP, Addison PS, Neitenbach AM, Bergese SD, Kelley SD. Accuracy of continuous non-invasive respiratory rate derived from pulse oximetry in patients with high respiratory rates. Abstracts of papers presented at the, 2013 annual meeting of the society for technology in anesthesia (STA). Anesth Analg Suppl. 2013;2013(117):49.

56.

Kelley SD, Neitenbach AM, Kinney AR, Mestek ML. Detection of opioid-induced respiratory depression with pulse oximetry derived respiratory rate monitoring. Abstract A095. Am Soc Anesth. 2012;Washington, DC.

57.

Mestek ML, Addison PS, Watson JN, Neitenbach AM, Ochs JP. Accuracy of continuous non-invasive respiratory rate derived from pulse oximetry during coached breathing. I.A.M.P.O.V. 2012 Symposium, Yale University, New Haven, CT, USA. 29 June–1 July 2012.

58.

Addison PS, Mestek ML, Watson JN, Neitenbach AM, Ochs JP. Continuous respiration rate derived from pulse oximetry during cold-room hypoxia. I.A.M.P.O.V. 2012 Symposium, Yale University, New Haven, CT, USA. 29 June–1 July 2012.

59.

Mestek ML, Addison PS, Neitenbach AM, Bergese SD, Kelley SD. Accuracy of continuous non-invasive respiratory rate derived from pulse oximetry in the postanesthesia care unit. Abstract 094, American Soc Anesth, Annual Meeting, October 13–17, 2012; Washington, DC.

60.

Mestek ML, Addison PS, Kinney AR, Kelley SD. Accuracy of continuous non-invasive respiratory rate derived from pulse oximetry in obese subjects. Abstract A561, American Soc. Anesth., Annual Meeting, October 13–17, 2012; Washington, DC.

61.

Mestek ML, Addison PS, Neitenbach AM, Bergese SD, Kelley SD. Accuracy of continuous noninvasive respiratory rate derived from pulse oximetry in congestive heart failure patients. Chest 2012;142 (4_MeetingAbstracts):113A.

62.

Mestek ML, Addison PS, Neitenbach AM, Bergese SD, Kelley SD. Accuracy of continuous noninvasive respiratory rate derived from pulse oximetry in chronic obstructive pulmonary disease patients. Chest 2012;142 (4_MeetingAbstracts): 671A.

Title: Pulse oximetry-derived respiratory rate in general care floor patients
Authors: Paul S. Addison
James N. Watson
Michael L. Mestek
James P. Ochs
Alberto A. Uribe
Sergio D. Bergese
Publication date: 01-02-2015
Publisher: Springer Netherlands
Published in: Journal of Clinical Monitoring and Computing / Issue 1/2015
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-014-9575-5

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Pulse oximetry-derived respiratory rate in general care floor patients

Abstract

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Abstract

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