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At least 109 records · Page 6Linked to original sources
PubMed2006

Measurement of respiratory rate from the photoplethysmogram in chest clinic patients.

OBJECTIVE: We studied the application of our algorithm for the robust extraction of respiratory information from the pulse oximeter signal acquired from a selection of patients attending the chest clinic. METHODS: Photoplethysmograms were obtained from 16 individuals: 13 patients with various conditions in the respiratory ward and three healthy subjects. Wavelet transforms were generated from which respiratory information was extracted to obtain a measure of respiratory rate. This measured rate was compared with the respiratory rate determined by one of a variety of other means (a digital end tidal CO(2) signal, the output from a non-invasive ventilation device, or a switch actuated by the patient or observer.) RESULTS: Respiratory rates varied from 6.2 to 35.8 breaths per minute (bpm). The oximeter rate determined through our method matched the marker rate obtained for all patients to within 1 bpm. CONCLUSION: The technique allows the measurement of respiratory rate directly from the photoplethysmogram of a pulse oximeter, and leads the way for development of a simple non-invasive combined respiration and saturation monitor useful for patients with all forms of breathlessness.

Adult↗
PubMed2002

Influence of respiratory rate on gas trapping during low volume ventilation of patients with acute lung injury.

OBJECTIVE: Reduction in tidal volume (Vt) associated with increase in respiratory rate to limit hypercapnia is now proposed in patients with acute lung injury (ALI). The aim of this study was to test whether a high respiratory rate induces significant intrinsic positive end-expiratory pressure (PEEPi) in these patients. DESIGN: Prospective crossover study. SETTING: A medical intensive care unit. INTERVENTIONS AND MEASUREMENTS: Ten consecutive patients fulfilling criteria for severe ALI were ventilated with a 6 ml/kg Vt, a total PEEP level at 13+/-3 cmH(2)O and a plateau pressure kept at 23+/-4 cmH(2)O. The respiratory rate was randomly set below 20 breaths/min (17+/-3 breaths/min) and increased to 30 breaths/min (30+/-3 breaths/min) to compensate for hypercapnia. External PEEP was adjusted to keep the total PEEP and the plateau pressure constant. PEEPi was computed as the difference between total PEEP and external PEEP. The lung volume retained by PEEPi was then measured. RESULTS: Increase in respiratory rate resulted in significantly higher PEEPi (1.3+/-0.4 versus 3.9+/-1.1 cmH(2)O, p<0.01) and trapped volume (70+/-43 versus 244+/-127 ml, p<0.01). External PEEP needed to be reduced from 11.9+/-3.4 to 9.7+/-2.9 cmH(2)O ( p<0.01). PaO(2) was not affected but the alveolar-arterial oxygen tension difference slightly worsened with the high respiratory rate (p<0.05). CONCLUSIONS: An increase in respiratory rate used to avoid Vt reduction-induced hypercapnia may induce substantial gas trapping and PEEPi in patients with ALI.

Adult↗
PubMed1994

Effect of pulmonary lymphatic obstruction on respiratory rate and airway rapidly adapting receptor activity in rabbits.

1. The effects on respiratory rate of obstruction of pulmonary lymph flow, reduction of plasma protein concentration and a combination of the two procedures were examined in anaesthetized rabbits. The former was achieved by raising the pressure in a pouch created from the right external jugular vein and the latter by batch plasmapheresis. 2. In spontaneously breathing rabbits, neither pulmonary lymphatic obstruction (n = 6) nor plasmapheresis (n = 5) produced a significant change in respiratory rate. However, their combination (n = 8) produced a significant increase in respiratory rate (P < 0.05). 3. Cooling of the cervical vagi to 8-9 degrees C (n = 4) and vagotomy (n = 7) abolished this response. 4. There was a significant increase in the activity of the airway rapidly adapting receptors (RARs; n = 9) during pulmonary lymphatic obstruction, plasmapheresis and their combination (P < 0.05). 5. It is concluded that in the rabbit, obstruction of lymphatic drainage from the lung after plasmapheresis causes a reflex increase in respiratory rate. The afferent pathway for this reflex response lies in the vagus nerve and the RARs are likely to be the receptors involved in this response.

Action Potentials↗
PubMed2003

Standard pulse oximeters can be used to monitor respiratory rate.

BACKGROUND: One of the most important limitations of standard pulse oximeters is the inability to detect changes in respiratory rate until oxygenation is affected. This study sought to determine if analysis of the plethysmogram by wavelet transforms would enable the determination of changes in respiratory rate at an earlier stage. METHODS: Ten healthy adult volunteers were monitored, breathing at baseline and predetermined respiratory rates, using a standard pulse oximeter. Photo-plethysmograms captured in an attached lap top computer were then analysed using wavelet transforms. RESULTS: Determination of baseline respiratory rate and subsequent changes including apnoea were easily identified. COMMENT: Wavelet transforms permit the accurate determination of respiratory rate by a standard pulse oximeter.

Humans↗
PubMed1993

A new respiratory rate monitor: development and initial clinical experience.

The need for continuous, noninvasive, and reliable respiratory rate monitoring during recovery from general anesthesia has long been recognized. Alternative principles can be grouped into those detecting the respiratory effort, and those detecting the actual result, i.e. the respiratory gas flow. The second category is of greatest interest for patient monitoring. In this paper, we report the development and initial clinical experience with a new acoustic air-flow sensor. By differential, multipoint detection of the air-flow in the mouth and nose region, the sensor can easily discriminate against different kinds of interference, including motion artefacts. The sensor is nonexpensive, rugged, simple to apply and inherently safe. An instrument with continuous display of respiratory rate, and an audiovisual apnea alarm has been designed and built. The complete system has been tested on patients during recovery after general anesthesia. In 16 patients, the respiratory rate displayed by the instrument has been correlated against that visually observed. A good correlation was obtained. Minor discrepancies can be explained from the fact that visual observation corresponds to the respiratory effort, whereas the sensor detects the actual air flow. In 12 patients, 24 hour simultaneous recordings were made of respiratory rate with the new sensor, with simultaneous recording of the oxygen saturation and the heart rate with a pulse oximeter. It was found that the new sensor reliably recorded respiratory depression and apnea. Such events may in some patients be as frequent as one incident per hour. One case of 'Ondine's curse' provided clear evidence that pulse oximetry has a low sensitivity to respiratory disorders.

Adult↗
PubMed1985

Respiratory effects of epidural fentanyl. Changes in end-tidal CO2 and respiratory rate following single doses and continuous infusions of epidural fentanyl.

Respiratory function following single bolus doses as well as continuous infusions of epidural fentanyl were studied in 21 patients. Respiratory rate decreased significantly and end-tidal CO2 showed a non-significant increase following single doses of epidural fentanyl (1.5 micrograms/kg). These changes occurred within minutes of injection, but could not be attributed solely to rapid systemic absorption of fentanyl from the epidural space. Prior administration of parenteral morphine resulted in significantly higher end-tidal CO2 concentrations and lower respiratory rates following epidural fentanyl. Continuous epidural fentanyl infusion (0.5 micrograms/kg/hour) started 60 minutes after the bolus dose had no effect on end-tidal CO2 concentration or respiratory rate for up to 18 hours. Infusions were continued after the study terminated for up to 9 days, during which there was no clinically significant respiratory depression.

Adult↗
PubMed2006

A fully automated algorithm for the determination of respiratory rate from the photoplethysmogram.

OBJECTIVE: To determine if an automatic algorithm using wavelet analysis techniques can be used to reliably determine respiratory rate from the photoplethysmogram (PPG). METHODS: Photoplethysmograms were obtained from 12 spontaneously breathing healthy adult volunteers. Three related wavelet transforms were automatically polled to obtain a measure of respiratory rate. This was compared with a secondary timing signal obtained by asking the volunteers to actuate a small push button switch, held in their right hand, in synchronisation with their respiration. In addition, individual breaths were resolved using the wavelet-method to identify the source of any discrepancies. RESULTS: Volunteer respiratory rates varied from 6.56 to 18.89 breaths per minute. Through training of the algorithm it was possible to determine a respiratory rate for all 12 traces acquired during the study. The maximum error between the PPG derived rates and the manually determined rate was found to be 7.9%. CONCLUSION: Our technique allows the accurate measurement of respiratory rate from the photoplethysmogram, and leads the way for developing a simple non-invasive combined respiration and saturation monitor.

Adult↗
PubMed2004

Medullary lateral tegmental field: control of respiratory rate and vagal lung inflation afferent influences on sympathetic nerve discharge.

We used spectral analysis and event-triggered averaging to determine the effects of chemical inactivation of the medullary lateral tegmental field (LTF) on 1) the relationship of intratracheal pressure (ITP, an index of vagal lung inflation afferent activity) to sympathetic nerve discharge (SND) and phrenic nerve activity (PNA) and 2) central respiratory rate in paralyzed, artificially ventilated dial-urethane-anesthetized cats. ITP-SND coherence value at the frequency of artificial ventilation was significantly (P<0.05; n=18) reduced from 0.73+/-0.04 (mean+/-SE) to 0.24+/-0.04 after bilateral microinjection of muscimol into the LTF. Central respiratory rate was unexpectedly increased in 12 of these experiments (0.28+/-0.03 vs. 0.95+/-0.25 Hz). The ITP-PNA coherence value was variably affected by chemical inactivation of the LTF. It was unchanged when central respiratory rate was also not altered, decreased when respiratory rate was increased above the rate of artificial ventilation, and increased when respiratory rate was raised from a value below the rate of artificial ventilation to the same frequency as the ventilator. Chemical inactivation of the LTF increased central respiratory rate in four of six vagotomized cats but did not significantly affect the PNA-SND coherence value. These data demonstrate that the LTF 1) plays a critical role in mediating the effects of vagal lung inflation afferents on SND but not PNA, 2) helps maintain central respiratory rate in the physiological range, but 3) is not involved in the coupling of central respiratory and sympathetic circuits.

Animals↗
PubMed1993

Effect of bradykinin on respiratory rate in anaesthetized rabbits; role of rapidly adapting receptors.

1. This study was performed in anaesthetized, spontaneously breathing rabbits: (a) to determine the effect of bradykinin administered into the right atrium on the respiratory rate, and (b) to elucidate the potential role of rapidly adapting receptors (RARs) in mediating this effect. The role of RARs was established by graded cooling of the cervical vagi. The respiratory rate was measured from an intrapleural pressure tracing. 2. Dose-response curves relating right atrial injections of bradykinin (0.25, 0.5, 1.0 and 1.5 micrograms/kg) to the respiratory rate were established in the control state (i.e. vagi at 37 degrees C). The respiratory rate increased significantly (P < 0.01, ANOVA) from a control value of 51.3 +/- 6.8 breaths/min by 12 +/- 3, 25 +/- 5, 43 +/- 7 and 58 +/- 11% respectively. At doses of 1.0 and 1.5 micrograms/kg I.V., the increase in rate was preceded by apnoea. 3. The dose-response curves were repeated with bolus injections of bradykinin (0.25, 0.5, 1.0 and 1.5 micrograms/kg) after cooling the cervical vagi to 8-9 degrees C. The increase in respiratory rate was attenuated significantly (P < 0.01 ANOVA). The rate increased from a control value of 27.2 +/- 2.1 breaths/min by 5 +/- 2, 6 +/- 2, 16 +/- 5 and 21 +/- 8% respectively. With vagi cooled, apnoea was increased in duration and occurred at lower doses. On rewarming vagi, the original responses were reestablished. 4. When the study was repeated after bilateral vagotomy, apnoea was abolished but there was a small residual increase in rate. This increase was similar to that seen after cooling the vagi (P > 0.05). 5. RAR (n = 5) activity was recorded from the cervical vagus. Right atrial injections of bradykinin (0.25-1.0 micrograms/kg) stimulated RARs. On cooling the vagi to 8-9 degrees C caudal to the recording site, the increase in activity was blocked. 6. These data support the proposition that bradykinin increases the respiratory rate in rabbits and that this response is, in part, a reflex mediated by RARs. In addition, bradykinin has other secondary effects on respiration: an aponea which is mediated by non-myelinated vagal afferents and a small stimulatory effect on respiration which persists after bilateral vagotomy.

Adaptation, Physiological↗
PubMed2004

The effect of carbon dioxide, respiratory rate and tidal volume on human heart rate variability.

BACKGROUND: Heart rate variability (HRV) has been used for assessment of depth of anesthesia. Alterations in respiratory rate and tidal volume modulate the sympatovagal neural drive to the heart. The changes in PaCO2 that accompany changes in breathing pattern may, through chemoreceptors in the brainstem, independently influence the autonomic control of the heart and modulate HRV. METHODS: We measured the effects of PaCO2, tidal volume and respiratory rate on HRV during spontaneous and mechanical ventilation in 22 healthy volunteers and in 25 mechanically ventilated anesthetized patients. RESULTS: Adding CO2 to the inspiratory gas increased high frequency (HF) and low frequency (LF) components of HRV in awake volunteers both during spontaneous and mechanical ventilation, while this effect of CO2 was abolished in patients during anesthesia. Increase of tidal volume increased HF component of HRV only in volunteers during spontaneous ventilation. On the other hand, when respiratory rate was reduced, the balance of HF and LF power moved toward LF power in all study groups. Breathing frequency altered HRV independent on PaCO2, tidal volume and the level of consciousness. In contrast, the effect of PaCO2 appeared to be related to normal level of consciousness, suggesting that a cortical modulation of the autonomic nervous activity contributes to the effects of PaCO2 on HRV. CONCLUSIONS: PaCO2, tidal volume and respiratory rate should be controlled when HRV power spectrum is measured in conscious patients or volunteers, while in anesthetized patients small changes in end-tidal CO2 or tidal volume do not modulate HRV if respiratory rate remains unchanged.

Adult↗
PubMed1990

Respiratory rate during acute asthma.

Asthmatic patients hyperventilate during acute attacks, but controversy persists as to whether they breathe rapidly, deeply or both. We monitored respiratory rate under the three following conditions: (1) asthma treated in the emergency room; (2) airways obstruction provoked by methacholine inhalation; and (3) airways obstruction provoked by exercise. In 47 acutely ill asthmatic patients, respiratory rate was higher than in 42 nonasthmatic control patients in the emergency room. Pretreatment respiratory rate correlated with peak expiratory flow rate and forced expired volume in one second. In 17 asthmatic patients and 16 healthy volunteers, breathing pattern was monitored by respiratory inductance plethysmography. Methacholine inhalation and exercise provoked significant airways obstruction in asthmatic patients but not in control subjects. In asthmatic patients, minute ventilation and tidal volume increased above that of control subjects following methacholine and exercise, but the rate was no higher than in control subjects. We conclude that the respiratory rate is increased in naturally occurring asthma, but not when acute airways obstruction is induced transiently in the laboratory. In the former setting, the respiratory rate is correlated with spirometric measures of airflow obstruction, but the weakness of the correlation does not allow the respiratory rate to be used as a substitute for spirometry.

Acute Disease↗
PubMed2002

Respiratory rate measurement in adults--how reliable is it?

Measurement of respiratory rate (RR) is essential in the evaluation of respiratory disorders. However, the variability in RR measurement in adults has never been adequately assessed. Respiratory rate was measured twice in 245 patients; the two measurements were performed by the same observer in 137 patients, by different observers in 58 patients and simultaneously by different observers in 50 patients. The mean (SD) difference between the first and second measurements was 0.03 (3); 95% limits of agreement-4.86-4.94 breaths min(-1), -5.7-5.7 breaths min(-1), and -4.2 to 4.4 breaths min(-1) for the same observer, different observer and simultaneous observer groups, respectively. The difference in RR measurements did not vary with RR. In conclusions on average, there is very good agreement between observers in RR measurement. Inter-observer variability may account for a difference of up to 6 breaths min(-1). This is relevant when applying clinical prediction rules based on threshold RR values.

Adolescent↗
PubMed2003

Neural network for photoplethysmographic respiratory rate monitoring.

The reflection mode photoplethysmographic (PPG) signal was studied with the aim of determining respiratory rate. The PPG signal includes respiratory synchronous components, seen as frequency modulation of the heart rate (respiratory sinus arrhythmia), amplitude modulation of the cardiac pulse and respiratory-induced intensity variations (RIIVs) in the PPG baseline. PPG signals were recorded from the foreheads of 15 healthy subjects. From these signals, the systolic wave-form, diastolic waveform, respiratory sinus arrhythmia, pulse amplitude and RIIVs were extracted. Using basic algorithms, the rates of false positive and false negative detection of breaths were calculated separately for each of the five components. Furthermore, a neural network was assessed in a combined pattern recognition approach. The error rates (sum of false positive and false negative breath detections) for the basic algorithms ranged from 9.7% (pulse amplitude) to 14.5% (systolic waveform). The corresponding values for the neural network analysis were 9.5-9.6%. These results suggest the use of a combined PPG system for simultaneous monitoring of respiratory rate and arterial oxygen saturation (pulse oximetry).

Adult↗
PubMed1990

Rating respiratory disability: a report on behalf of a working group of the European Society for Clinical Respiratory Physiology.

A rating procedure for respiratory disability has been developed; it entails measuring the symptom-limited maximal oxygen uptake or estimating the maximal uptake from the results of a submaximal exercise test and other relevant variables. The derivation assumes a linear scale of disability between the limits 0% and 100% which are defined. The percentage disability of 157 men with respiratory limitation of exercise has been used to delineate empirical grades of disability. These are of similar form to those used for grading respiratory impairment. More information is needed with a view to validation.

Disability Evaluation↗
PubMed2005

Effect of tidal volume and respiratory rate on the power of breathing calculation.

BACKGROUND: The power of breathing (PoB) is used to estimate the mechanical workload of the respiratory system. Aim of this study was to investigate the effect of different tidal volume-respiratory rate combinations on the PoB when the elastic load is constant. In order to assure strict control of the experimental conditions, the PoB was calculated on an airway pressure-volume curve in mechanically ventilated patients. METHODS: Ten patients received three different tidal volume-respiratory rate combinations while minute ventilation was constant. Respiratory mechanics, PoB and its elastic and resistive components were calculated. Alternative methods to estimate the elastic workload were assessed: elastic work of breathing per litre per minute, elastic workload index (the square root of elastic work of breathing multiplied by respiratory rate) and elastic double product of the respiratory system (the elastic pressure multiplied by respiratory rate). RESULTS: Despite constant elastance and minute ventilation, the elastic PoB showed an increment greater than 200% from the lower to the greater tidal volume, accounting for approximately 80% of the whole PoB increment. On the contrary, elastic work of breathing per litre per minute, elastic workload index and elastic double product did not change. CONCLUSION: Changes in breathing pattern markedly affect the PoB despite constant mechanical load. Other indexes could assess the elastic workload without tidal volume dependence. Power of breathing use should be avoided to compare different mechanical loads or efficiencies of the respiratory muscles when tidal volume is variable.

Aged↗
PubMed2003

The G glycoprotein of respiratory syncytial virus depresses respiratory rates through the CX3C motif and substance P.

Respiratory syncytial virus (RSV) infection in the neonate can alter respiratory rates, i.e., lead to episodes of apnea. We show that RSV G glycoprotein reduces respiratory rates associated with the induction of substance P (SP) and G glycoprotein-CX3CR1 interaction, an effect that is inhibited by treatment with anti-G glycoprotein, anti-SP, or anti-CX3CR1 monoclonal antibodies. These data suggest new approaches for treating some aspects of RSV disease.

Animals↗
PubMed1981

Evaluation of two electronic respiratory rate monitoring systems.

Two electronic systems for monitoring respiratory rates in critical care patients were evaluated--one a system using impedance sensors and the other a system using thermistor sensors. The thermistor sensor, attached to a nasal cannula or air-entrainment mask, was connected to a sensitivity calibrating control and a digital display module. The impedance system consisted of three electrocardiogram chest leads connected to an identical digital display module. Each of 10 patients was simultaneously monitored by both systems; indicated rates from the two systems were then compared to a counted control rate to determine accuracy. Data were collected at 17 successive half-hour intervals. Analysis of variance of the data gave a significant F ratio for differences among the three methods of rate monitoring. The impedance system gave readings progressively higher and the thermistor system gave readings progressively lower than the counted control rates. This study indicates that this configuration for both impedance and thermistor sensing lacks the desired accuracy for respiratory rate monitoring but may be suitable for apnea alarms.

Evaluation Studies as Topic↗