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Monitoring of respiratory rate in postoperative care using a new photoplethysmographic technique
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
2000 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 16, no 4, 309-315 p.Article in journal (Refereed) Published
Abstract [en]

Objective.Photoplethysmography (PPG) is a non-invasive optical technique that measures variations in skin blood volume and perfusion. The PPG signal contains components that are synchronous with respiratory and cardiacrhythms. We undertook this study to evaluate PPG for monitoring patients' respiratory rate in the postoperative care unit, using a new prototype device. We compared it with the established technique, transthoracic impedance (TTI).

Methods.PPG signals from 16 patients(ASA classes 1–2, mean age 43 years) who were recovering from general anaesthesia after routine operations were recorded continuously for 60minutes/patient. The respiratory synchronous part of the PPG signal was extracted by using a band pass filter. Detection of breaths in the filtered PPG signals was done both visually and by using an automated algorithm. In both procedures, the detected breaths were compared with the breaths detected in the TTI reference.

Results.A total of 10.661 breaths were recorded, and the mean ± SD respiratory rate was 12.3 ± 3.5breaths/minute. When compared with TTI, the rates of false positive and false negative breaths detected by PPG (visual procedure) were 4.6 ±4.5% and 5.8 ± 6.5%, respectively. When using the algorithm for breath detection from PPG, the rates of false positive andfalse negative breaths were 11.1 ± 9.7% and 3.7 ±3.8%, respectively, when compared to TTI. Lower respiratory rates increased the occurrence of false-positive breaths that were detected by the PPG using visual identification (p< 0.05). The same tendency was seen with the automated PPG procedure (p< 0.10).

Conclusions.Our results indicate that PPG has the potential to be useful for monitoring respiratory rate in the postoperative period.

Place, publisher, year, edition, pages
2000. Vol. 16, no 4, 309-315 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26704DOI: 10.1023/A:1011424732717Local ID: 11296OAI: oai:DiVA.org:liu-26704DiVA: diva2:247254
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-27Bibliographically approved
In thesis
1. Respiratory monitoring using reflection mode photoplethysmography: clinical and physiological aspects
Open this publication in new window or tab >>Respiratory monitoring using reflection mode photoplethysmography: clinical and physiological aspects
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Photoplethysmography (PPG) is a non-invasive optical technique for monitoring variations in blood volume and blood flow in skin and other tissues. Light from a light-emitting diode is absorbed, scattered and reflected from the skin, and detected by a photodetector as a plethysmogram. The plethysmogram contains variations of different frequencies. The most clinically utilised is the pulse synchronous variation in the PPG application pulse oximetry, but there is also a respiratory rate synchronous variation (PPGt).

The aims of this work were to evaluate PPG as a clinical method for detection of breaths during anaesthesia, postoperative and intensive care, and to investigate possible circulatory factors in the physiological background of the respiratory synchronous part of the reflection mode PPG signal.

It was concluded that respiratory variations in reflection mode PPG derived from the forearm could be detected with high sensitivity and specificity. PPG, was not significantly affected by awake or anaesthetised state, though indirect signs of reduced sympathetic tone in the anaesthetic state were present, or by spontaneous or positive pressure ventilation. There were no significant differences between men and women or between young and old subjects. Circulatory pressure variations in phase with respiration were present on both the arterial and venous side and they showed the same degree of variation, as did PPG when provoking respiration. Squared coherence, cross-correlation and visual techniques for evaluating time differences were equally good.

Respiratory monitoring in the clinical setting is challenging and no golden standard exists. Methods based on airflow are mostly considered advantageous in detecting apnoea, but are less well tolerated by patients. The results indicate that PPG has a potential as a tool for monitoring respiratory rate. It is non-invasive, well tolerated and can be used for continuous monitoring.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2005. 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 898
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-31535 (URN)17335 (Local ID)91-8529-905-7 (ISBN)17335 (Archive number)17335 (OAI)
Public defence
2005-05-26, Elsa Brändström-salen, Universitetssjukhuset, Linköping, 12:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-27Bibliographically approved

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Nilsson, LenaJohansson, AndersKalman, Sigga

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