Skip to main content

Monitoring of respiratory rate in postoperative care using a new photoplethysmographic technique

Journal of Clinical Monitoring and Computing volume 16, pages 309–315 (2000)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

REFERENCES

  1. Jones JG, Sapsford DJ, Wheatley RG. Postoperative hypoxaemia: mechanisms and time course. Anaesthesia 1990; 45: 566–573

    PubMed  CAS  Google Scholar 

  2. Nimmo AF, Drummond GB. Respiratory mechanics after abdominal surgery measured with continuous analysis of pressure, Flow and volume signals. Br J Anaesth 1996; 77: 317–326

    PubMed  CAS  Google Scholar 

  3. Gill NP, Wright B, Reilly CS. Relationship between hypoxaemic and cardiac ischaemic events in the perioperative period. Br J Anaesth 1992; 68: 471–473

    PubMed  CAS  Google Scholar 

  4. Rosenberg J, Kehlet H. Postoperative mental confusion — association with postoperative hypoxemia. Surgery 1993; 114: 76–81

    PubMed  CAS  Google Scholar 

  5. Drummond GB, Nimmo AF, Elton RA. Thoracic impedance used for measuring chest wall movement in post-operative patients. Br J Anaesth 1996; 77: 327–332

    PubMed  CAS  Google Scholar 

  6. Cyna AM, Kulkarni V, Tunstall ME, et al. Aura: A new respiratory monitor and apnoea alarm for spontaneously breathing patients. Br J Anaesth 1991; 67: 341–345

    PubMed  CAS  Google Scholar 

  7. Gordh T, Rawal N, Stroöm S, Hoök B. Respiratory monitoring during postoperative analgesia. J Clin Monit 1995; 11: 365–372

    PubMed  CAS  Article  Google Scholar 

  8. Cohn MA, Rao ASV, Broudy M, et al. The respiratory inductive plethysmograph: A non-invasive monitor of respiration. Bull Eur Physiopathol Respir 1982; 18: 643–658

    PubMed  CAS  Google Scholar 

  9. Anderson W, Brock-Utne AJ, Brock-Utne JG, Brodsky JB. Evaluation of a respiratory rate monitor in post-surgical patients. J Clin Anesth 1992; 4: 289–291

    PubMed  CAS  Article  Google Scholar 

  10. Tremper KK, Barker SJ. Pulse oximetry. Anesthesiology 1989; 70: 98–108

    PubMed  CAS  Google Scholar 

  11. Moöller JT, Johannessen NW, Espersen K, et al. Randomized evaluation of pulse oximetry in 20,802 patients: II. Anesthesiology 1993; 78: 445–453

    CAS  Article  Google Scholar 

  12. Dumas C, Wahr JA, Tremper KK. Clinical evaluation of a prototype motion artifact resistant pulse oximeter in the recovery room. Anesth Analg 1996; 83: 269–272

    PubMed  CAS  Article  Google Scholar 

  13. Standards of the American Society of Anesthesiologists. Standards for postanesthesia care. Last amended on October 19, 1994; http://www.asahg.org

  14. Kamal AAR, Harness JB, Irving G, Mearns AJ. Skin photoplethysmography — a review. Comp Methods Prog Biomed 1989; 28: 257–269

    CAS  Article  Google Scholar 

  15. Nilsson L, Johansson A, Svanerudh J, Kalman S. Is the respiratory component of the photoplethysmographic signal of venous origin? Med Biol Eng Comput 1999; 37 (Suppl 2): 912–913

    Google Scholar 

  16. Ugnell H. The respiratory synchronous photoplethys-mographic signal. Its dependence on light wavelength and sample volume. Med Biol Eng Comput 1996; 34 (Suppl 1, pt1): 275–276

    Google Scholar 

  17. Dorlas JC, Nijboer JA. Photo-electric plethysmography as a monitoring device in anaesthesia. Br J Anaesth 1985; 57: 524–530

    PubMed  CAS  Google Scholar 

  18. Johansson A, Öberg PÅ, Sedin G. Monitoring of heart and respiratory rates in newborn infants using a new photoplethysmographic technique. J Clin Monit 1999; 15: 461–467

    CAS  Article  Google Scholar 

  19. Johansson A, Nilsson L, Kalman S, Öberg PÅ. Monitoring of Respiratory Rates using Photoplethysmography, 20th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Hong Kong, 1998, Report No. 3226

  20. Lindberg L-G, Ugnell H, Öberg PÅ. Monitoring of respiratory and heart rates using a fibre-optic sensor. Med Biol Eng Comput 1992; 30: 533–537

    PubMed  CAS  Google Scholar 

  21. Larsen PD, Harty M, Thiruchelvam M, Galletly DC. Spectral analysis of AC and DC components of the pulse photoplethysmograph at rest and during induction of anaesthesia. Int J Clin Monit Comput 1997; 14: 89–95

    PubMed  CAS  Article  Google Scholar 

  22. Johansson A, Öberg PÅ Estimation of respiratory volumes from the photoplethysmographic signal. Part 1: Experimental results. Med Biol Eng Comput 1999; 37: 42–47

    PubMed  CAS  Google Scholar 

  23. Galletly DC, Williams TB, Robinson BJ. Periodic cardiovascular and ventilatory activity during midazolam sedation. Br J Anaesth 1996; 76: 503–507

    PubMed  CAS  Google Scholar 

  24. Hayes MJ, Smith PR. Artifact reduction in photoplethysmography. Applied Optics 1998; 37: 7437–7446

    Article  PubMed  CAS  Google Scholar 

  25. Tur E, Tur M, Maibach HI, Guy RH. Basal perfusion of the cutaneous microcirculation: Measurements as a function of anatomic position. J Invest Dermatol 1983; 81: 442–446

    PubMed  CAS  Article  Google Scholar 

  26. Ziege S, Schmid-Schoönbein H, Grebe R, Martin E. Long-term registration of cutaneous microcirculation during general anesthesia. Int J Microcirc Clin Exp 1997; 17: 385–394

    PubMed  CAS  Article  Google Scholar 

  27. Hall JM, Lampotang S, Thoman J, et al. A continuous respiratory rate monitor derived from the optoplethys-mogram of a pulse oximeter: Clinical evaluation. Anesthesiology 1998; 89 (3A): A 971

    Google Scholar 

  28. Wiklund L, Hoök B, Staåhl K, Jordeby-Joönsson A. Post-anesthesia monitoring revisited: frequency of true and false alarms from different monitoring devices. J Clin Anesth 1994; 6: 182–188

    PubMed  CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden

    Lena Nilsson & Sigga Kalman

  2. Department of Biomedical Engineering, Linköping University, Linköping, Sweden

    Anders Johansson

Authors
  1. Lena Nilsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anders Johansson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sigga Kalman
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Nilsson, L., Johansson, A. & Kalman, S. Monitoring of respiratory rate in postoperative care using a new photoplethysmographic technique. J Clin Monit Comput 16, 309–315 (2000). https://doi.org/10.1023/A:1011424732717

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1011424732717

  • Photoplethysmography
  • non-invasive measurement
  • anaesthesia recovery period
  • respiratory rate