title: Respiration can be monitored by photoplethysmography with high sensitivity and specificity regardless of anaesthesia and ventilatory mode.
abstract: BACKGROUND
  Photoplethysmography (PPG) is a non-invasive optical technique used, for instance, in pulse oximetry. Beside the pulse synchronous component, PPG has a respiratory synchronous variation (PPGr). Efforts have been made to utilize this component for indirect monitoring of respiratory rate and volume. Assessment of the clinical usefulness as well as of the physiological background of PPGr is required. We evaluated if anaesthesia and positive-pressure ventilation would affect PPGr.
  
  
  METHODS
  We recorded reflection mode PPGr, at the forearm, and the respiratory synchronous changes in central venous pressure (CVP), peripheral venous pressure (PVP) and arterial blood pressure (ABP) in 12 patients. Recordings for each patient were made on three occasions: awake with spontaneous breathing; anaesthetized with spontaneous breathing; and anaesthetized with positive-pressure ventilation. We analyzed the sensitivity, specificity, coherence and time relationship between the signals.
  
  
  RESULTS
  PPGr sensitivity for breath detection was [mean (SD)] >86(21)% and specificity >96(12)%. Respiratory detection in the macrocirculation (CVP, PVP and ABP) showed a sensitivity >83(29)% and specificity >93(12)%. The coherence between signals was high (0.75-0.99). The three measurement situations did not significantly influence sensitivity, specificity or time shifts between the PPGr, PVP, ABP, and the reference CVP signal despite changes in physiological data between measurements.
  
  
  CONCLUSIONS
  A respiratory synchronous variation in PPG and all invasive pressure signals was detected. The reflection mode PPGr signal seemed to be a constant phenomenon related to respiration regardless of whether or not the subject was awake, anaesthetized or ventilated, which increases its clinical usefulness in respiratory monitoring.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden. lena.nilsson@lio.se
authors.forename: L
authors.initials: L
authors.lastname: Nilsson
authors.forename: A
authors.initials: A
authors.lastname: Johansson
authors.forename: S
authors.initials: S
authors.lastname: Kalman
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005542:Forearm / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017156:Photoplethysmography / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012119:Respiration; D015656:Respiratory Mechanics / Q000502:physiology; D012143:Respiratory Physiological Phenomena; D012680:Sensitivity and Specificity; D012881:Skin Temperature / Q000502:physiology