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• W4313647890 abstract "Respiratory rate is a key clinical indicator1, 2 as well as a core component of paediatric clinical scoring systems and for example guidelines from the National Institute for Health and Care Excellence (NICE) in the United Kingdom.3, 4 However, accurate measurement can be difficult without use of specialist equipment. Studies have highlighted that manual counting of respiratory rate can be unreliable;2 by its very nature, visual assessment of movement of the chest or abdomen to assess respiratory rate is intermittent, labour-intensive, and it is frequently omitted in busy clinical settings.3 Increased respiratory rate is an early feature of respiratory disease such as pneumonia and asthma, and hence continuous monitoring may help as an early indicator to alert clinicians of possible deterioration.5, 6 Furthermore the need for reliable measurement of respiratory rate for use in low resource regions to aid diagnosis of pneumonia in children has been highlighted.5 In intensive care, respiratory rate is likely to be monitored as part of standard monitoring using methods such as thoracic impedance pneumography and capnography.7 However, such monitoring equipment may not be available in less intensive environments such as emergency departments, paediatric wards, or the home. Methods for respiratory rate monitoring such as respiratory inductance plethysmography (RIP) bands, nasal thermistor or nasal cannula pressure/flow are used for example in sleep studies but require additional equipment on the child, and are often poorly tolerated by young children. Thus a number of groups have looked into developing straightforward, reliable and accurate techniques for continuous monitoring of respiratory rate. Several approaches to measure respiratory rate have been or are currently being investigated some of which are direct measurements and other approaches derive respiratory rate from analysis of other signals; examples of such methods include using heart rate or ECG variations, breath sounds as well as thermal imaging.8 We have used analysis of the oximetry plethysmogram trace to extract respiratory rate in infants and children.6, 9, 10 Several groups have applied microwave sensors to monitor heart rate and respiratory rate at a distance for example in the 1996 Olympics.11 More recently this type of approach has been used for example in respiratory rate monitoring in adults from an intensive care unit ceiling7 as well as studying breathing rate and patterns in premature infants.12 A key advantage of microwave sensors is that like thermal imaging, the measurement is not only non-invasive but also does not involve contact and it has been suggested measurements should not be affected by blankets or clothing.7, 12 Possible limitations of this approach may be for example how sensitive such a system is to the distance between the sensor and patient as well as whether patient position and movement affect the performance and in addition considerations related to the importance of limiting exposure to microwaves. The interesting study by Katoh et al.13 in this issue of Acta Paediatrica uses a microwave radar system to monitor respiratory rate as well as heart rate in children between 3 and 15 years old in a paediatric outpatients department; the paper explains that the power density spectrum conforms to requirements in Japan. The authors developed a system to distinguish between inhalation and exhalation and furthermore their system was also able to monitor heart rate. Respiratory rate was compared with visual assessment and heart rate was compared with pulse rate from an oximeter with the microwave radar monitor system about 10 cm from the thoracoabdominal region in sitting patients. Bland Altman analysis of respiratory rate agreement indicated a mean difference of 0.61 and limits of agreement between −3.7 and 4.9 with the range of mean respiratory rate of the two methods between about 12 and 40 min−1. Of 32 patients recruited four were excluded because of movement artefact issues. Measurements of both respiratory rate and heart rate could be obtained in 15 s. The authors also suggest that performance using the microwave system should not be affected by clothing thickness;13 it may help to see if tests could look into whether clothing type has any influence on measurements. The susceptibility of this technique to movement artefact and the duration measurements could reasonably be made over, appears to need further evaluation. Nevertheless this system has been shown to have good agreement with manual counting of respiratory rate and thus potentially this approach may provide a useful method for non-invasive and non-contact monitoring of respiratory rate as well as heart rate. Respiratory rate is an important clinical marker in paediatrics, but continued reliance on manual counting undermines its value. A range of newer techniques to allow respiratory rate monitoring are now available; these need to be rigorously assessed in pragmatic clinical studies in ill children. David Wertheim and Paul Seddon have been investigators in research projects extracting respiratory data from pulse oximetry plethysmogram waveforms, which have received funding from the National Institute for Health Research (NIHR) in the UK, Linde Healthcare REAL Fund and the Cystic Fibrosis Trust." @default.
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• W4313647890 date "2023-01-05" @default.
• W4313647890 modified "2023-10-06" @default.
• W4313647890 title "Measuring respiratory rate in children" @default.
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• W4313647890 doi "https://doi.org/10.1111/apa.16645" @default.
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