L'Her Erwan, N'Guyen Quang-Thang, Pateau Victoire, Bodenes Laetitia, Lellouche François
Réanimation Médicale, LATIM INSERM UMR 1101, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 22 rue Camille Desmoulins, 29609, Brest Cedex, France.
Médecine Intensive et Réanimation, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609, Brest Cedex, France.
Ann Intensive Care. 2019 Jan 21;9(1):11. doi: 10.1186/s13613-019-0485-z.
Respiratory rate is among the first vital signs to change in deteriorating patients. The aims of this study were to evaluate the accuracy of respiratory rate measurements using a specifically dedicated reflection-mode photoplethysmographic signal analysis in a pathological condition (PPG-RR) and to validate its implementation within medical devices.
This study is derived from a data mining project, including all consecutive patients admitted to our ICU (ReaSTOC study, ClinicalTrials.gov identifier: NCT02893462). During the evaluation phase of the algorithm, PPG-RR calculations were retrospectively performed on PPG waveforms extracted from the data warehouse and compared with RR reference values. During the prospective phase, PPG-RR calculations were automatically and continuously performed using a dedicated device (FreeO, Oxynov, Québec, QC, Canada). In all phases, reference RR was measured continuously using electrical thoracic impedance and chronometric evaluation (Manual-RR) over a 30-s period.
In total, 201 ICU patients' recordings (SAPS II 51.7 ± 34.6) were analysed during the retrospective evaluation phase, most of them being admitted for a respiratory failure and requiring invasive mechanical ventilation. PPG-RR determination was available in 95.5% cases, similar to reference (22 ± 4 vs. 22 ± 5 c/min, respectively; p = 1), and well correlated with reference values (R = 0.952; p < 0.0001), with a low bias (0.1 b/min) and deviation (± 3.5 b/min). Prospective estimation of the PPG-RR on 30 ICU patients' recordings was well correlated with the reference method (Manual-RR; r = 0.78; p < 0.001). Comparison of the methods depicted a low bias (0.5 b/min) and acceptable deviation (< ± 5.5 b/min).
According to our results, PPG-RR is an interesting approach for ventilation monitoring, as this technique would make simultaneous monitoring of respiratory rate and arterial oxygen saturation possible, thus minimizing the number of sensors attached to the patient. Trial registry number ClinicalTrials.gov identifier NCT02893462.
呼吸频率是病情恶化患者最早出现变化的生命体征之一。本研究的目的是评估在病理状态下使用专门的反射模式光电容积脉搏波信号分析（PPG-RR）测量呼吸频率的准确性，并验证其在医疗设备中的应用。
本研究源于一个数据挖掘项目，纳入了所有连续入住我们重症监护病房的患者（ReaSTOC研究，ClinicalTrials.gov标识符：NCT02893462）。在算法评估阶段，对从数据仓库中提取的PPG波形进行回顾性PPG-RR计算，并与RR参考值进行比较。在前瞻性阶段，使用专用设备（FreeO，Oxynov，魁北克，加拿大）自动连续进行PPG-RR计算。在所有阶段，通过电胸阻抗和计时评估（Manual-RR）在30秒内连续测量参考RR。
在回顾性评估阶段，共分析了201例重症监护病房患者的记录（简化急性生理学评分II为51.7±34.6），其中大多数因呼吸衰竭入院并需要有创机械通气。95.5%的病例可进行PPG-RR测定，与参考值相似（分别为22±4次/分钟和22±5次/分钟；p = 1），且与参考值相关性良好（R = 0.952；p < 0.0001），偏差较低（0.1次/分钟）且离散度较小（±3.5次/分钟）。对30例重症监护病房患者记录进行的PPG-RR前瞻性估计与参考方法（Manual-RR）相关性良好（r = 0.78；p < 0.001）。方法比较显示偏差较低（0.5次/分钟）且离散度可接受（<±5.5次/分钟）。
根据我们的结果，PPG-RR是一种用于通气监测的有趣方法，因为该技术可同时监测呼吸频率和动脉血氧饱和度，从而减少附着在患者身上的传感器数量。试验注册号ClinicalTrials.gov标识符NCT02893462。
