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Respiration Rate Monitoring Methods: a Review Farah Q Al-Khalidi, Reza Saatchi, Derek Burke, Heather E Elphick, Stephen Tan

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Respiration Rate Monitoring Methods: a Review Farah Q Al-Khalidi, Reza Saatchi, Derek Burke, Heather E Elphick, Stephen Tan Respiration Rate Monitoring Methods: A Review Farah Q Al-Khalidi, Reza Saatchi, Derek Burke, Heather E Elphick, Stephen Tan To cite this version: Farah Q Al-Khalidi, Reza Saatchi, Derek Burke, Heather E Elphick, Stephen Tan. Respira- tion Rate Monitoring Methods: A Review. Pediatric Pulmonology, Wiley, 2011, 46 (6), pp.523. 10.1002/ppul.21416. hal-00612787 HAL Id: hal-00612787 https://hal.archives-ouvertes.fr/hal-00612787 Submitted on 31 Jul 2011 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Pediatric Pulmonology Respiration Rate Monitoring Methods: A Review For Peer Review Journal: Pediatric Pulmonology Manuscript ID: PPUL-10-0195.R2 Wiley - Manuscript type: State of the Art Date Submitted by the 19-Nov-2010 Author: Complete List of Authors: Al-Khalidi, Farah; Sheffield Hallam University, Faculty of ACES Saatchi, Reza; Sheffield Hallam University, Faculty of ACES Burke, Derek; Sheffield Children's Hospital, Emergency Department Elphick, Heather; Sheffield Children's Hospital Tan, Stephen; Sheffield Hallam University, Faculty of ACES Keywords: respiratory, thermal imaging, non-contact John Wiley & Sons, Inc. Page 1 of 46 Pediatric Pulmonology 1 2 Respiration Rate Monitoring Methods: A Review 3 4 5 F.Q. AL-Khalidi 1, R. Saatchi 1, D. Burke 2, H. Elphick 2 and S. Tan 1 6 7 1 8 Faculty of ACES, Sheffield Hallam University, Sheffield, U.K. 9 10 2 Sheffield Children's NHS Foundation Trust, Sheffield, U.K. 11 12 13 14 15 16 17 18 Author for correspondence: 19 20 For Peer Review 21 Name: Heather E Elphick 22 23 24 Address: Floor E, Stephenson Unit, Sheffield Children’s Hospital, Western Bank, 25 26 Sheffield S10 2TH, UK 27 28 Tel: (0)114 2717585 29 30 31 Email: [email protected] 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Short Title: Respiration Rate Monitoring Methods 51 52 53 54 1 55 56 57 58 59 60 John Wiley & Sons, Inc. Pediatric Pulmonology Page 2 of 46 1 2 Summary 3 4 5 Respiration rate is an important indicator of a person's health, and thus it is 6 7 monitored when performing clinical evaluations. There are different approaches for 8 9 respiration monitoring, but generally they can be classed as contact or noncontact. 10 11 For contact methods, the sensing device (or part of the instrument containing it) is 12 13 attached to the subject's body. For noncontact approaches the monitoring is 14 15 performed by an instrument that does not make any contact with the subject. 16 17 In this paper a review of respiration monitoring approaches (both contact and 18 19 noncontact) is provided. Concerns related to the patient's recording comfort, 20 For Peer Review 21 recording hygiene, and the accuracy of respiration rate monitoring have resulted in 22 23 the development of a number of noncontact respiration monitoring approaches. 24 25 26 A description of thermal imaging based and vision based noncontact respiration 27 28 monitoring approaches we are currently developing is provided. 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 Keywords: Respiratory, thermal imaging, noncontact 48 49 50 51 52 53 54 2 55 56 57 58 59 60 John Wiley & Sons, Inc. Page 3 of 46 Pediatric Pulmonology 1 2 1. Introduction 3 4 5 Breathing is an important physiological task in living organisms. For humans, this 6 7 process results in air containing oxygen being inhaled into the lungs, where gas 8 9 exchange occurs across the alveolar-capillary membrane (1). Carbon Dioxide is 10 11 excreted as part of the process, in the air released through the nose or mouth. The 12 13 entire process from the inhalation to exhalation is known as a breathing (or 14 15 respiration) cycle. 16 17 18 19 Respiratory rate is a vital sign used to monitor the progression of illness and an 20 For Peer Review 21 abnormal respiratory rate is an important marker of serious illness. There is 22 23 substantial evidence that alterations in respiratory rate can be used to predict 24 25 potentially serious clinical events such as cardiac arrest or admission to the intensive 26 27 care unit (2-5). These studies have shown respiratory rate to be better than other 28 29 vital measurements such as pulse and blood pressure in discriminating between 30 31 stable patients and patient at risk (3). Using changes in respiratory rate 32 33 measurements patients could have been identified as high risk up to 24 hours before 34 the event with a specificity of 95% (5). Hospital systems such as the Paediatric Early 35 36 Warning System (PEWS) have been developed to encourage appropriate responses 37 38 to abnormal vital signs including an elevated respiratory rate. 39 40 41 42 43 44 Evidence from a recent audit of febrile children in our unit suggests that in both the 45 46 emergency department and the acute medical admissions unit, respiratory rate was 47 48 only measured in around two thirds of children on arrival. Reasons for omission were 49 50 given as “crying” or “unsettled” and in many of these children experienced nursing 51 52 53 54 3 55 56 57 58 59 60 John Wiley & Sons, Inc. Pediatric Pulmonology Page 4 of 46 1 2 staff were unable to obtain an accurate reading. However, it is in these children that 3 4 this measurement would potentially be most useful and important. 5 6 7 8 9 10 According to Murthy (6), existing devices for monitoring respiratory rate only estimate 11 12 the actual breathing rate due to their limitations. These devices can be classified in 13 14 different ways, depending on the manner in which they operate and how they are 15 used. In this paper, respiration rate monitoring devices are grouped as either contact 16 17 or noncontact. In contact respiration rate monitoring, the instrument makes direct 18 19 contact with the subject's body. However, in noncontact monitoring, the respiration 20 For Peer Review 21 rate is measured without the instrument making contact with the subject's body. 22 23 There are clear advantages to noncontact respiration monitoring methods. These 24 25 include improved patient comfort (especially for long term monitoring) as the subject 26 27 is not tied to an instrument and improved accuracy as distress caused by a contact 28 29 device may alter the respiration rate. 30 31 32 33 There have been several studies reporting developments in both contact and non- 34 35 contact respiration monitoring. A review of non-invasive respiratory monitoring in 36 37 medical care was provided by Folke et al. (7). This paper aims to review the 38 39 literature on contact and non-contact methods of respiratory rate monitoring, 40 41 including two methods currently being developed by our unit. 42 43 44 45 46 47 2. Contact Based Respiration Monitoring 48 49 Contact respiration rate monitoring instruments are usually based on measuring one 50 51 of the following parameters: respiratory sounds, respiratory airflow, respiratory 52 53 54 4 55 56 57 58 59 60 John Wiley & Sons, Inc. Page 5 of 46 Pediatric Pulmonology 1 2 related chest or abdominal movements, respiratory CO 2 emission and oximetry 3 4 probe SpO2. Respiration rate can also be derived from the electrocardiogram 5 6 (ECG). 7 8 9 10 11 12 2.1 Acoustic Based Methods 13 14 Respiratory sound can be measured using a microphone placed either close to the 15 16 respiratory airways or over the throat to detect the variation of sound. Then a 17 18 frequency analysis and estimation of the loudness of the sound can be carried out 19 20 (8). For Peer Review 21 22 23 Werthammer et al. (9) reported a respiratory sounds measurement system to detect 24 25 sleep apnea in infants. The system depended on recording a signal derived from 26 27 breathing sounds from the nose. This method was applied to eight premature 28 29 infants. Snorting, speaking, crying, coughing etc had a negative effect on the 30 31 operation of the system. 32 33 Corbishley and Rordriguez-Villegas (10) proposed a miniaturised and wearable 34 35 respiration monitoring respiration system. It used a microphone mounted on the 36 37 neck to obtain the largest breathing acoustic. 38 39 40 2.2 Airflow Based Methods 41 42 Airflow can be detected because exhaled air is warmer, has higher humidity and 43 44 contains more CO than inhaled air. These variations can be used for indicating the 45 2 46 respiratory rate. Most airflow-sensing methods need a sensor, attached to the 47 48 airways (7). The measurement of the airflow can be achieved by using a nasal or 49 50 oronasal thermistor which detects changes in temperature between the inhaled and 51 52 53 54 5 55 56 57 58 59 60 John Wiley & Sons, Inc. Pediatric Pulmonology Page 6 of 46 1 2 exhaled air. This gives a semi-quantitative estimate of airflow, but the method is 3 4 limited due to a high incidence of thermistor displacement (11). 5 6 7 The nasal pressure transducer is another sensor used to measure respiration rate.
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