title: Early experience with remote pressure sensor respiratory plethysmography monitoring sedation in the MR scanner.
abstract: OBJECTIVE
  The importance of monitoring the breathing pattern during sedation of children undergoing magnetic resonance scans is indicated in guidelines, but no appropriate magnetic resonance-compatible devices are available. We report preliminary findings from a technique referred to as remote pressure sensor respiratory plethysmography.
  
  
  METHODS
  A data acquisition system was developed, enabling measurement of respiratory rate, plethysmogram amplitude, proportion of inspiratory time over cycle time, thoraco-abdominal phase shift and sigh rate. Correlation between plethysmogram amplitude and tidal volume was investigated on adult volunteers. Twenty-seven children undergoing sedation were monitored with remote pressure sensor respiratory plethysmography, in addition to SPO2 and PetCO2. Differences in monitoring parameters were searched for among three groups: patients who received chloral hydrate only (chloral succeeded, CS group), those who received a supplementation of sodium thiopental (chloral failed, CF group), and those who were sedated with sodium thiopental directly (no chloral, NC group). Correlations were searched for among monitoring parameters, and with total dose of thiopental. The long-term behaviour of respiratory rate, proportion of inspiratory time over cycle time and phase shift was studied.
  
  
  RESULTS
  Plethysmogram amplitude was found to correlate linearly with tidal volume (r>0.92), with a slope varying up to 22%. While 11% of patients did not tolerate the capnometric probe and readings were discontinuous in 26%, all of them tolerated remote pressure sensor respiratory plethysmography belts. Sighs and non-respiratory movements of the torso could be distinguished on remote pressure sensor respiratory plethysmography waveforms. No significant inter-group differences were found in PetCO2, SPO2, respiratory rate and phase shift. Proportion of inspiratory time over cycle time was higher in the NC group when compared to the CS group (0.497+/-0.03 vs. 0.463+/-0.008; P=0.02), the CF group being characterized by intermediate values (0.480+/-0.008); when compared to the CS group, sigh rate was lower in the CF group (0.04+/-0.04 vs. 0.14+/-0.08; P=0.04) and in the NC group (0.06+/-0.05 vs. 0.14+/-0.08, P=0.03). A positive correlation was found between total dose of thiopental and proportion of inspiratory time over cycle time, with r=0.4 and P=0.04. A large baseline variability in phase shift was found. No long-term trends predictive of patient movement could be identified.
  
  
  CONCLUSIONS
  Breathing pattern monitoring is feasible through pneumatic devices, which are well tolerated. The resulting correlation with changes in tidal volume can be better when compared to visual inspection. Proportion of inspiratory time over cycle time and sigh rate convey information related to the state of the sedated patient. These results are not specific to the technology employed, and large-scale studies on the clinical usefulness of breathing pattern monitoring are motivated.
authors.affiliation: Istituto Nazionale Neurologico Carlo Besta IRCCS, Department of Neuro-Anaesthesiology, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Caldiroli
authors.forename: L
authors.initials: L
authors.lastname: Minati
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation; D016343:Monitoring, Intraoperative / Q000379:methods*; D010991:Plethysmography / Q000379:methods*; D011312:Pressure; D012119:Respiration; D012129:Respiratory Function Tests / Q000295:instrumentation / Q000379:methods; D015656:Respiratory Mechanics / Q000502:physiology