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Abstract
Respiration rate (RR) is a critical vital sign that provides early detection of respiratory compromise. The acoustic technique of measuring continuous respiration rate (RRa) interprets the large airway sound envelope to calculate respiratory rate while pulse oximetry-derived respiratory rate (RRoxi) interprets modulations of the photoplethsymograph in response to hemodynamic changes during the respiratory cycle. The aim of this study was to compare the performance of these technologies to each other and to a capnography-based reference device. Subjects were asked to decrease their RR from 14 to 4 breaths per minute (BPM) and then increase RR from 14 to 24 BPM. The effects of physiological noise, ambient noise, and head movement and shallow breathing on device performance were also evaluated. The test devices were: (1) RRa, Radical-7 (Masimo Corporation), (2) RRoxi, Nellcor™ Bedside Respiratory Patient Monitoring System (Medtronic), and (3) reference device, Capnostream20p™ (Medtronic). All devices were configured with their default settings. Twenty-nine healthy adult subjects were included in the study. During abrupt changes in breathing, overall RRoxi was accurate for longer periods of time than RRa; specifically, RRoxi was more accurate during low and normal RR, but not during high RR. RRoxi also displayed a value for significantly longer time periods than RRa when the subjects produced physiological sounds and moved their heads, but not during shallow breathing or ambient noise. RRoxi may be more accurate than RRa during development of bradypnea. Also, RRoxi may display a more reliable RR value during routine patient activities.
Highlights
Respiration rate (RR) is a critical vital sign that provides early detection of patient distress and respiratory compromise, a state in which there is a high likelihood of deterioration into respiratory insufficiency, respiratory failure or death
We evaluated the effects of changes in RR and depth along with the effects of physiological and environmental noises and subject head movements on R Roxi and RRa accuracy
Five subjects reported a prior history of smoking and six subjects were current smokers (4.67 cigarettes per day on average)
Summary
Respiration rate (RR) is a critical vital sign that provides early detection of patient distress and respiratory compromise, a state in which there is a high likelihood of deterioration into respiratory insufficiency, respiratory failure or death. During respiratory compromise, specific interventions (e.g., enhanced monitoring, therapies) might prevent or mitigate this deterioration [1, 2]. Current clinical practices for respiratory rate monitoring lag behind. The microcirculatory failure causes a progressive decline in the efficiency of gas exchange in the lungs [8]. The increased minute ventilation that occurs in this state causes a greater volume of oxygen to be ventilated into the lungs, while the SpO2 levels remain unchanged, masking the respiratory distress of the patient.
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