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Respiratory rate is recognized as a clinically important parameter for monitoring respiratory status on the general care floor (GCF). Currently, intermittent manual assessment of respiratory rate is the standard of care on the GCF. This technique has several clinically-relevant shortcomings, including the following: (1) it is not a continuous measu...
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Citations
... Wireless thoracic impedance techniques now exist ( Fig. 1), and a recent study suggests high accuracy in measuring RR in general ward patients [22]. Other wearable sensors use accelerometers to detect chest movements [23] and the physiologic respiratory variation in pulse oximetry waveforms to estimate RR [24]. For patients staying in bed, a contact-free piezoelectric sensor, positioned under the mattress, has also been proposed to monitor RR [25]. ...
The early detection of clinical deterioration could be the next significant step in enhancing patient safety in general hospital wards. Most patients do not deteriorate suddenly; instead, their vital signs are often abnormal or trending towards an abnormal range hours before severe adverse events requiring rescue intervention and/or ICU transfer. To date, at least 10 large clinical studies have demonstrated a significant reduction in severe adverse events when heart rate, blood pressure, oxygen saturation and/or respiratory rate are continuously monitored on medical and surgical wards. Continuous, silent, and automatic monitoring of vital signs also presents the opportunity to eliminate unnecessary spot-checks for stable patients. This could lead to a reduction in nurse workload, while significantly improving patient comfort, sleep quality, and overall satisfaction. Wireless and wearable sensors are particularly valuable, as they make continuous monitoring feasible even for ambulatory patients, raising questions about the future relevance of “stay-in-bed” solutions like capnography, bed sensors, and video-monitoring systems. While the number of wearable sensors and mobile monitoring solutions is rapidly growing, independent validation studies on their sensitivity and specificity in detecting abnormal vital signs in actual patients, rather than healthy volunteers, remain limited. Additionally, further research is needed to evaluate the cost-effectiveness of using wireless wearables for vital sign monitoring both within hospital wards and at home.
... However, a new device (Nellcor ™ PM1000N, Medtronic Japan, Co. Ltd., Tokyo, Japan) that facilitates the concurrent measurement of the respiratory rate and percutaneous oxygen saturation is now available. The veracity of this device has been substantiated in cohorts undergoing low-flow oxygen therapy and in healthy individuals [3,[19][20][21]. However, the efficacy of Nellcor PM1000N (PM1000N) in gauging the respiratory rate in HFNC-utilizing patients remains unclear. ...
Recently, the Nellcor PM1000N was developed for the concurrent assessment of respiratory rate and percutaneous oxygen saturation. However, the validation of respiratory rate measurements in patients receiving a high-flow nasal cannula (HFNC) using the PM1000N remains unestablished. Therefore, this study aimed to assess the validity of respiratory rate measurements obtained using PM1000N in patients receiving HFNC.
A retrospective assessment was conducted on the respiratory rate measurements obtained using the PM1000N and electrocardiogram (ECG) impedance methods in comparison to those visually assessed by nurses. This evaluation included patients admitted to the Intensive Care Unit (ICU) of Sapporo Medical University Hospital who received HFNC between June 2022 and December 2022. Correlation coefficients, intraclass correlation coefficients (ICCs), Bland–Altman plots, and t-tests were employed to assess the concordance between the visually observed respiratory rates by nurses and those recorded by the PM1000N and ECG impedance.
Twenty patients were enrolled in this study. Among them, 119 instances of respiratory rate were recorded. The ICCs for the PM1000N and impedance methods were 0.918 and 0.846, respectively, compared with the rates visually assessed by nurses. The mean differences were p = 0.947 (95% CI −3.186 to 0.2987) and p < .001 (95% CI 16.4609–17.9532), respectively.
The PM1000N demonstrated superiority over ECG impedance in measuring respiratory rate in patients with HFNC. Furthermore, PM1000N shows promise for effective application in patients receiving HFNC.
... Nevertheless, with improved algorithms, rPPG could potentially be more robust in detecting accurate SpO 2 results below 95%. For RR however, the standard for routine care remains to be manual counting (36), as conventionally, even pulse oximetry is not able to accurately capture this vital sign (37,38). ...
Background
Advancements in medical technologies have led to the development of contact-free methods of haemodynamic monitoring such as remote photoplethysmography (rPPG). rPPG uses video cameras to interpret variations in skin colour related to blood flow, which are analysed to generate vital signs readings. rPPG potentially ameliorates problems like fretfulness and fragile skin contact associated with conventional probes in children. While rPPG has been validated in adults, no prior validation has been performed in children.
Methods
A two-phased prospective cross-sectional single-centre study was conducted from January to April 2023 to evaluate the feasibility, acceptability, and accuracy of obtaining heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO2) using rPPG in children, compared to the current standard of care. In Phase 1, we recruited patients ≤16 years from the neonatal and paediatric wards. We excluded preterm neonates with gestational age <35 weeks and newborns <24 hours old. The rPPG webcam was positioned 30 cm from the face. After 1 minute of facial scanning, readings generated were compared with pulse oximetry for HR and SpO2, and manual counting for RR. Correlation and Bland-Altman analyses were performed. In Phase 2, we focused on the population in whom there was potential correlation between rPPG and the actual vital signs.
Results
Ten neonates and 28 children aged 5 to 16 years were recruited for Phase 1 (765 datapoints). All patients were haemodynamically stable and normothermic. Patients and caregivers showed high acceptability to rPPG. rPPG values were clinically discrepant for children <10 years. For those ≥10 years, moderate correlation was observed for HR, with Spearman’s correlation coefficient (Rs) of 0.50 [95% confidence intervals (CI): 0.42, 0.57]. We performed Phase 2 on 23 patients aged 12 to 16 years (559 datapoints). Strong correlation was observed for HR with Rs=0.82 (95% CI: 0.78, 0.85). There was weak correlation for SpO2 and RR (Rs=−0.25 and −0.02, respectively).
Conclusions
Our study showed that rPPG is acceptable and feasible for neonates and children aged 5 to 16 years, and HR values in older children aged 12 to 16 years correlated well with the current standard. The rPPG algorithms need to be further refined for younger children, and for obtaining RR and SpO2 in all children. If successful, rPPG will provide a viable contact-free alternative for assessing paediatric vital signs, with potential use in remote monitoring and telemedicine.
... The veracity of this device has been substantiated in cohorts undergoing low-ow oxygen therapy and in healthy individuals (3,(19)(20)(21). However, the e cacy of Nellcor PM1000N (PM1000N) in gauging the respiratory rate in HFNC-utilizing patients remains unclear. ...
Purpose: Recently, the Nellcor PM1000N was developed for the concurrent assessment of respiratory rate and percutaneous oxygen saturation. However, the validation of respiratory rate measurements in patients receiving a high-flow nasal cannula (HFNC) using the PM1000N remains unestablished. Therefore, this study aimed to assess the validity of respiratory rate measurements obtained using PM1000N in patients receiving HFNC.
Methods: A retrospective assessment was conducted on the respiratory rate measurements obtained using the PM1000N and electrocardiogram (ECG) impedance methods in comparison to those visually assessed by nurses. This evaluation included patients admitted to the Intensive Care Unit (ICU) of Sapporo Medical University Hospital who received HFNC between June 2022 and December 2022. Correlation coefficients, intraclass correlation coefficients (ICCs), Bland-Altman plots, and t-tests were employed to assess the concordance between the visually observed respiratory rates by nurses and those recorded by the PM1000N and ECG impedance.
Results: Twenty patients were enrolled in this study. Among them, 119 instances of respiratory rate were recorded. The ICCs for the PM1000N and impedance methods were 0.918 and 0.846, respectively, compared with the rates visually assessed by nurses. The mean differences were p=0.947 (95% CI: -3.186 – 0.2987) and p < .001 (95% CI: 16.4609–17.9532), respectively.
Conclusion: The PM1000N demonstrated superiority over ECG impedance in measuring respiratory rate in patients with HFNC. Furthermore, PM1000N shows promise for effective application in patients receiving HFNC.
... Patients presenting to the ED with a respiratory rate exceeding 22 breaths per minute (tachypnea) was a top predictor for ICU admission. Respiratory rate changes are an important marker often preceding major complications, including respiratory depression, and failure [20]. Since COVID-19 has the potential to affect the respiratory system [21], changes in resting respiratory rate might occur in the early stages of infection [22]. ...
Background
Adult cancer patients with COVID-19 were shown to be at higher risk of Intensive Care Unit (ICU) admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations studied. Therefore, this study aimed to identify predictors of ICU admission (demographic, clinical, and COVID-19 targeted medications) in cancer patients with active COVID-19 infection presenting to the Emergency Department (ED).
Methods
This is a retrospective cohort study. It was conducted on adult cancer patients older than 18 years who presented to the American University of Beirut Medical Center ED from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant data were extracted from electronic medical records. The association between different variables and ICU admission was tested. Logistic regression was done to adjust for confounding variables. A p-value less than 0.05 was considered significant.
Results
Eighty-nine distinct patients were included. About 37% were admitted to the ICU (n = 33). Higher ICU admission was seen in patients who had received chemotherapy within one month, had a respiratory rate at triage above 22 breaths per minute, oxygen saturation less than 95%, and a higher c-reactive protein upon presentation to the ED. After adjusting for confounding variables, only recent chemotherapy and higher respiratory rate at triage were significantly associated with ICU admission.
Conclusion
Physicians need to be vigilant when taking care of COVID-19 infected cancer patients. Patients who are tachypneic at presentation and those who have had chemotherapy within one month are at high risk for ICU admission.
... RRp is measured by the change in the following pulse oximeter signals: plethysmograph baseline modulation, pulse amplitude modulation, and respiratory sinus arrhythmia [12]. For measuring RRp of general care patients, the patients were not sedated and were asked to relax and breathe naturally; it was in excellent agreement with RRc. ...
During moderate sedation for gastrointestinal endoscopic submucosal dissection (ESD), monitoring of ventilatory function is recommended. We compared the following techniques of respiratory rate (RR) measurement with respiratory sound (RRa): capnography (RRc), thoracic impedance (RRi), and plethysmograph (RRp). This study enrolled patients aged ≥ 20 years who underwent esophageal (n = 19) and colorectal (n = 5) ESDs. RRc, RRi, RRp, and RRa were measured by Capnostream™ 20P, BSM-2300, Nellcor™ PM1000N, and Radical-7®, respectively. In total, 413 RR data were collected from the esophageal ESD group and 114 RR data were collected from the colorectal ESD group. Compared with RRa during colorectal ESD, that during esophageal ESD had larger bias [95% limit of agreement (LOA)] with RRc [1.9 (− 11.0–14.8) vs. − 0.4 (− 2.9–2.2)], RRi [9.4 (− 16.8–9.4) vs. − 1.5 (− 12.0–8.9)], and RRp [0.3 (− 5.7–6.4) vs. 0.2 (− 3.2–3.6)]. Of the correct RR values displayed during esophageal ESD, > 90% were measured as RRa and RRp. Moreover, RRc was a useful parameter during colorectal ESD. To maximize patient safety during ESD under sedation, endoscopists and medical staff should know the feature and principle of the devices used for RR measurement. During esophageal ESD, RRa and RRp may be a good parameter to detect bradypnea or apnea. RRc, RRa and RRp are useful for reliable during colorectal ESD.
Trial registration UMIN-CTR (UMIN000025421).
... The PPG signal contains vital information that can be extracted as respiratory rate (RR) [142], blood oxygen saturation (SpO 2 ) [143] (Figure 4A), blood pressure (BP) [144], and cardiac output [145]. Moreover, it was demonstrated to be possible to extract clinical physiological parameters directly from the measured PPG signal such as vascular assessment and autonomic function [146]. ...
The development of new biosensor technologies and their active use as wearable devices have offered mobility and flexibility to conventional western medicine and personal fitness tracking. In the development of biosensors, transducers stand out as the main elements converting the signals sourced from a biological event into a detectable output. Combined with the suitable bio-receptors and the miniaturization of readout electronics, the functionality and design of the transducers play a key role in the construction of wearable devices for personal health control. Ever-growing research and industrial interest in new transducer technologies for point-of-care (POC) and wearable bio-detection have gained tremendous acceleration by the pandemic-induced digital health transformation. In this article, we provide a comprehensive review of transducers for biosensors and their wearable applications that empower users for the active tracking of biomarkers and personal health parameters.
... Since COVID-19 has the potential to affect the respiratory system [20], it sounds rational to suggest that changes in resting respiratory rate might occur in the early stages of infection [21]. Respiratory rate changes is an important marker often preceding major complications, including respiratory depression, and failure [22]. High respiratory rates displayed the ability to predict most of in-hospital cardiac arrests as well as admission to the intensive care unit [23]. ...
Study Objective:
Adult cancer patients with COVID-19 were shown to be at higher risk of ICU admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations studied. The aim of this study was to detect the predictors of ICU admission for adult COVID-19 patients with cancer who present to the emergency department (ED).
Methods:
Theis a retrospective cohort study. It was conducted on adult cancer patients older than 18 years who presented to the EDof the American University of Beirut MedicalCenter from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant electronic data were extracted. The association between different variables and ICU admission was tested. Logistic regression was done to adjust for confounding variables. P value less than 0.05 was considered significant.
Results:
Eighty-nine distinct patients were included. About 37% were admitted to the ICU (n=33). Higher ICU admission was seen in patients who had received chemotherapy within one month, had a respiratory rate at triage > 22 breaths per minute, an oxygen saturation < 95%, and/or a higher CRP upon presentation to the ED. After adjusting for confounding variables only recent chemotherapy and higher respiratory rate at triage were significantly associated with ICU admission.
Conclusion:
Physicians need to be vigilant when taking care of covid infected oncology patients. Patients who are tachypneic at presentation and those who have had chemotherapy within one month are at high risk for ICU admission.
... Davis et al. found lead times for variations in physiological features following infection of non-human primates, finding significant heart rate increase approximately two days prior to a fever 32 . Other studies have found that respiratory rate changes may precede decreases in oxygen saturation [33][34][35] and abnormalities of respiration have been identified as one the most important indications of clinical deterioration 36 . ...
The COVID-19 pandemic has accelerated the adoption of innovative healthcare methods, including remote patient monitoring. In the setting of limited healthcare resources, outpatient management of individuals newly diagnosed with COVID-19 was commonly implemented, some taking advantage of various personal health technologies, but only rarely using a multi-parameter chest-patch for continuous monitoring. Here we describe the development and validation of a COVID-19 decompensation index (CDI) model based on chest patch-derived continuous sensor data to predict COVID-19 hospitalizations in outpatient-managed COVID-19 positive individuals, achieving an overall AUC of the ROC Curve of 0.84 on 308 event negative participants, and 22 event positive participants, out of an overall study cohort of 400 participants. We retrospectively compare the performance of CDI to standard of care modalities, finding that the machine learning model outperforms the standard of care modalities in terms of both numbers of events identified and with a lower false alarm rate. While only a pilot phase study, the CDI represents a promising application of machine learning within a continuous remote patient monitoring system.
... Typically, strain sensors are used to derive RR, but it can also be examined with electrocardiograms [105], optical fibers, pulse oximetry [106], polymer-based transducer sensors [107], and IMUs on the chest or back [108,109]. All of these methods can be integrated into multimodal systems that simultaneously record HR, RR, and movement [110,111]. ...
Low-cost wearable sensors that are capable of accurately and robustly measuring and monitoring various markers of health or wellbeing will allow a new era of sports medicine provision. Technological advancements now allow clinicians to monitor individual athletes and groups or teams within a range of environments (clinic, home, training or matches/competition). Clinicians can examine movement and physiological data in order to assess and monitor injuries/rehabilitation or improve performance levels. This chapter will provide an overview of the available wearable sensors that can be used by sports medicine clinicians, which will help familiarize clinicians with the types of devices they could employ within their practice. We discuss the types of sensors, their current use and future applications in sports medicine.
