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Respiration can be monitored by photoplethysmography with high sensitivity and specificity regardless of anaesthesia and ventilatory mode
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.
2005 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, no 8, 1157-1162 p.Article in journal (Refereed) Published
Abstract [en]

Background:  Photoplethysmography (PPG) is a non-invasive optical technique used, for instance, in pulse oximetry. Beside the pulse synchronous component, PPG has a respiratory synchronous variation (PPGr). Efforts have been made to utilize this component for indirect monitoring of respiratory rate and volume. Assessment of the clinical usefulness as well as of the physiological background of PPGr is required. We evaluated if anaesthesia and positive-pressure ventilation would affect PPGr.

Methods:  We recorded reflection mode PPGr, at the forearm, and the respiratory synchronous changes in central venous pressure (CVP), peripheral venous pressure (PVP) and arterial blood pressure (ABP) in 12 patients. Recordings for each patient were made on three occasions: awake with spontaneous breathing; anaesthetized with spontaneous breathing; and anaesthetized with positive-pressure ventilation. We analyzed the sensitivity, specificity, coherence and time relationship between the signals.

Results:  PPGr sensitivity for breath detection was [mean (SD)] >86(21)% and specificity >96(12)%. Respiratory detection in the macrocirculation (CVP, PVP and ABP) showed a sensitivity >83(29)% and specificity >93(12)%. The coherence between signals was high (0.75–0.99). The three measurement situations did not significantly influence sensitivity, specificity or time shifts between the PPGr, PVP, ABP, and the reference CVP signal despite changes in physiological data between measurements.

Conclusion:  A respiratory synchronous variation in PPG and all invasive pressure signals was detected. The reflection mode PPGr signal seemed to be a constant phenomenon related to respiration regardless of whether or not the subject was awake, anaesthetized or ventilated, which increases its clinical usefulness in respiratory monitoring.

Place, publisher, year, edition, pages
2005. Vol. 49, no 8, 1157-1162 p.
Keyword [en]
general anaesthesia, monitoring, photoplethysmography, positive-pressure ventilation, respiration
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-31542DOI: 10.1111/j.1399-6576.2005.00721.xLocal ID: 17342OAI: oai:DiVA.org:liu-31542DiVA: diva2:252365
Available from: 2009-10-09 Created: 2009-10-09 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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