Abstract
Postoperative respiratory complications are common in patients after surgery. Respiratory depression and subsequent adverse outcomes can arise from pain, residual effects of drugs given during anaesthesia and administration of opioids for pain management. There is an urgent need for a continuous, real-time and non-invasive respiratory monitoring of spontaneously breathing postoperative patients. For this purpose, we used rib cage and abdominal respiratory effort belts for the respiratory monitoring pre- and postoperatively, with a new calibration method that enables accurate estimates of the respiratory airflow waveforms even when breathing style changes. Five patients were measured with respiratory effort belts and mask spirometer. Preoperative measurements were done in the operating room, whereas postoperative measurements were done in the recovery room. We compared five calibration models with pre- and postoperative training data. The postoperative calibration approach with two respiratory effort belts produced the most accurate respiratory airflow waveforms and tidal volume, minute volume and respiratory rate estimates. Average results for the best model were: coefficient of determination R2 was 0.91, tidal volume error 5.8%, minute volume error 8.5% and BPM (Breaths per Minute) error 0.21. The method performed well even in the following challenging respiratory cases: low airflows, thoracoabdominal asynchrony and hypopneic events. It was shown that a single belt measurement can be sufficient in some cases. The proposed method is able to produce estimates of postoperative respiratory airflow waveforms to enable accurate, continuous, real-time and non-invasive respiratory monitoring postoperatively. It provides also potential to optimize postoperative pain management and enables timely interventions.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Cepeda, M.S., Farrar, J.T., Baumgarten, M., Boston, R., Carr, D.B., Strom, B.L.: Side effects of opioids during short-term administration: effect of age, gender, and race. Clin. Pharmacol. Ther. 74(2), 102–112 (2003)
Etches, R.: Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can. J. Anaesth. 41(2), 125–132 (1994)
Gamil, M., Fanning, A.: The first 24 hours after surgery. A study of complications after 2153 consecutive operations. Anaesthesia 46, 712–715 (1991)
Taylor, S., Kirton, O.C., Staff, I., Kozol, R.A.: Postroperative day one: a high risk period for respiratory events. Am. J. Surg. 190(5), 752–756 (2005)
Ramsay, M.A.E., Usman, M., Lagow, E., Mendoza, M., Untalan, E., De Vol, E.: The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry. Anesth. Analg. 117(1), 69–75 (2013)
Mailey, J., Digiovine, B., Baillod, D., Gnam, G., Jordan, J., Rubinfeld, I.: Reducing hospital standardized mortality rate with early interventions. J. Trauma Nurs. 13(4), 178–182 (2006)
Schein, R.M.H., Hazday, N., Pena, M., Ruben, B.H., Sprung, C.L.: Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 98(6), 1388–1392 (1990)
George, J.A., Lin, E.E., Hanna, M.N., Murphy, J.D., Kumar, K., Ko, P.S., Wu, C.L.: The effect of intravenous opioid patient-controlled analgesia with and without background infusion on respiratory depression: a meta-analysis. J. Opioid Manag. 6(1), 47–54 (2010)
Lynn, L.A., Curry, J.P.: Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf. Surg. 5, 3 (2011)
Paine, C.W., Goel, V.V., Ely, E., Stave, C.D., Stemler, S., Zander, M., Bonafide, C.P.: Systematic review of physiologic monitor alarm characteristics and pragmatic interventions to reduce alarm frequency. J. Hosp. Med. 11(2), 136–144 (2016)
Wiklund, L., Hök, B., Ståhl, K., Jordeby-Jönsson, A.: Postanesthesia monitoring revisited: frequency of true and false alarms from different monitoring devices. J. Clin. Anesth. 6(3), 182–188 (1994)
Lovett, P.B., Buchwald, J.M., Sturmann, K., Bijur, P.: The vexatious vital: neither clinical measurements by nurses nor an electronic monitor provides accurate measurements of respiratory rate in triage. Ann. Emerg. Med. 45(1), 68–76 (2005)
Drummond, G.B., Bates, A., Mann, J., Arvind, D.K.: Characterization of breathing patterns during patient-controlled opioid analgesia. Br. J. Anaesth. 111(6), 971–978 (2013)
Voscopoulos, C.J., MacNabb, C.M., Brayanov, J., Qin, L., Freeman, J., Mullen, G.J., Ladd, D., George, E.: The evaluation of a non-invasive respiratory volume monitor in surgical patients undergoing elective surgery with general anesthesia. J. Clin. Monit. Comput. 29(2), 223–230 (2015)
Voscopoulos, C., Ladd, D., Campana, L., George, E.: Non-invasive respiratory volume monitoring to detect apnea in post-operative patients: case series. J. Clin. Med. Res. 6(3), 209–214 (2014)
Voscopoulos, C.J., MacNabb, C.M., Freeman, J., Galvagno, S.M., Ladd, D., George, E.: Continuous noninvasive respiratory volume monitoring for the identification of patients at risk for opioid-induced respiratory depression and obstructive breathing patterns. J. Trauma Acute Care Surg. 77(3), S208–S215 (2014)
Masa, J.F., Corral, J., Martin, M.J., Riesco, J.A., Sojo, A., Hernández, M., Douglas, N.J.: Assessment of thoracoabdominal bands to detect respiratory effort-related arousal. Eur. Respir. J. 22, 661–667 (2003)
Seppänen, T.M., Alho, O.-P., Seppänen, T.: Reducing the airflow waveform distortions from breathing style and body position with improved calibration of respiratory effort belts. Biomed. Eng. Online 12, 97 (2013)
Montgomery, D.C., Peck, E.A., Vining, G.G.: Introduction to Linear Regression Analysis, 3rd edn. Wiley, New York (2001)
Verschakelen, J.A., Demedts, M.G.: Normal thoracoabdominal motions. influence of sex, age, posture, and breath size. Am. J. Respir. Crit. Care Med. 151(2), 399–405 (1995)
Konno, K., Mead, J.: Measurement of separate volume changes of rib cage and abdomen during breathing. J. Appl. Physiol. 22(3), 407–422 (1967)
Voscopoulos, C., Brayanov, J., Ladd, D., Lalli, M., Panasyuk, A., Freeman, J.: Evaluation of a novel noninvasive respiration monitor providing continuous measurement of minute ventilation in ambulatory subjects in a variety of clinical scenarios. Anesth. Analg. 117(1), 91–100 (2013)
Acknowledgements
Finnish Cultural Foundation, North Ostrobothnia Regional Fund and International Doctoral Programme in Biomedical Engineering and Medical Physics (iBioMEP) are gratefully acknowledged for financial support.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this paper
Cite this paper
Seppänen, T.M., Alho, OP., Vakkala, M., Alahuhta, S., Seppänen, T. (2017). Continuous Postoperative Respiratory Monitoring with Calibrated Respiratory Effort Belts: Pilot Study. In: Fred, A., Gamboa, H. (eds) Biomedical Engineering Systems and Technologies. BIOSTEC 2016. Communications in Computer and Information Science, vol 690. Springer, Cham. https://doi.org/10.1007/978-3-319-54717-6_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-54717-6_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-54716-9
Online ISBN: 978-3-319-54717-6
eBook Packages: Computer ScienceComputer Science (R0)