Rainbow Acoustic Monitoring
RAM Overview
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Respiration Rate and Pulse Oximetry
Methods
Acoustic Respiration Rate (RRa)
RRa Accuracy
RRa Testimonials
Clinical Samples
Respiration Rate (RR):
A Complement to Pulse Oximetry
• Oxygen saturation is affected by
• Breathing rate and depth
• Lung function
• Heart function
• Relationship of RR to oxygen saturation
• Very low respiration rate can lead to oxygen desaturation
• Oxygen desaturation also caused by things other than low
respiration rate
• Benefit of respiration rate monitoring – in addition to pulse
oximetry - may be even greater when patient is on supplemental
oxygen
• A more comprehensive assessment of the patient includes:
• Oxygenation
• Ventilation
• Circulation
Respiration Rate
Respiration Depression
• Narcotic Induced Apnea
• PCA Pumps
• Epidural Narcotics
• Oral Narcotics
• Obstructive Sleep Apnea
(OSA)
• Neurologic Disorders
• Induce Central Apnea
Increased Respiration
• Tachypnea
• 1st sign of metabolic
decompensation
• Early indicator of physiologic
instability
Current Respiration Rate Methods
• Physical assessment (intermittent)
• Transthoracic impedance (continuous)
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Requires monitor and ECG electrodes
As chest expands impedance changes
Respiration rate measured from cyclical changes in impedance
No capital or increased sensor price (if already ECG monitoring)
• Capnography (continuous)
• Direct monitoring of the inhaled and exhaled concentration or partial
pressure of CO2 using sensor mask or nasal cannula
• Respiration rate measured by CO2 waveform analysis
• Shape of waveform can provide additional information
• Capital price is ~ $3K, sensor is $10-$15 per use
Recommendations: Post-Surgical Patient Monitoring
• The combination of patient-controlled analgesia and lower staff-to-patient ratios
on the general floor make it less likely that a clinician
will be there to observe an avoidable adverse event.
• The Anesthesia Patient Safety Foundation Recommends:
• “continuous monitoring of oxygenation (pulse oximetry) and
ventilation in non-ventilated patients receiving PCA, neuraxial opioids, or
serial doses of parenteral opiods”
• “It is critical that any monitoring system be linked to a reliable process to
summon a competent health care professional to the patient’s bedside in a
timely manner.”
Weinger MB. Dangers of Postoperative Opioids: APSF Workshop and White paper address prevention of postoperative respiratory complications. APSF Newsletter, 2006;21:61–7.
Respiration Rate Monitoring
• Respiration rate is a critical vital sign that provides early detection of
respiratory compromise and patient distress
• Continuous monitoring of respiration rate is especially important for
post-surgical patients receiving patient-controlled analgesia (PCA) for
pain management as the sedation can induce respiratory depression
and place patients at considerable risk of serious injury or death1-5
• Although the Anesthesia Patient Safety Foundation (APSF) guidelines
include oxygenation and ventilation monitoring in all patients receiving
opioids,6 current methods for respiration rate monitoring can be limited
by reliability or patient tolerance of nasal cannula
1
Joint Commission on Accreditation of Healthcare Organizations. Sentinel Event Alert: Patient controlled analgesia by proxy. Chicago: JCAHO, 2004
Institute for Safe Medication Practice. Safety issues with patient-controlled analgesia: Part I How errors occur. Huntingdon Valley: ISMP, 2003
3 Institute for Safe Medication Practices. Safety issues with patient-controlled analgesia: Part II How to prevent errors. Huntingdon Valley: ISMP, 2003
4 Bird M. Acute pain management: a new area of liability for anesthesiologists ASA Newsletter. Park Ridge: American Society of Anesthesiologists, 2007
5 Weinger MB. Dangers of Postoperative Opioids: APSF Workshop and White paper address prevention of postoperative respiratory complications. APSF Newsletter, 2006
6 Stoelting RK, Weinger MB. Dangers of Postoperative OpioidsﾑIs There a Cure? APSF Newsletter, 2009
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Acoustic Respiration Rate (RRa)
• When used with other clinical
variables, first-ever continuous
and noninvasive monitoring of
acoustic respiration rate (RRa)
may help clinicians assess
respiratory status and help
determine treatment options
Acoustic Respiration Rate (RRa):
How It Works
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Masimo Rainbow Acoustic Monitoring
noninvasively and continuously
measures respiration rate using an
innovative adhesive sensor with an
integrated acoustic transducer that is
easily and comfortably applied to the
patient’s neck.
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Using patented acoustic signal
processing that leverages Masimo’s
revolutionary Signal Extraction
Technology (SET), the respiratory
signal is separated and processed to
display continuous respiration rate.
FDA Accuracy Study: Methods
• Healthy adult subjects were instructed to breath at rates ranging from 4 to
30 breaths per minute (brpm)
• Waveforms were collected from both capnography and Rainbow Acoustic
devices
• Control reference was created
• First obtained by a trained observer marking each breath based on listening to
paired respiratory inspirations and expirations
• Then verified visually with capnography waveforms and by listening to
inspirations and expirations again (as done during auscultation)
• Respiratory rates were determined for the control reference from the verified
data
• Bias, standard deviation, and root mean square accuracy (ARMS) were
calculated for both capnography and Rainbow Acoustic devices compared
to the control respiration rate
RRa FDA Accuracy Results: Similar to
Capnography
FDA Submitted Accuracy, N=26 healthy volunteers
RRa Accuracy: Manual Method Comparison
• Comparison of
manual respiratory
rate by stethoscope
to Rainbow
Acoustic Monitor
RRa in 25 post
surgical recovery
patients
RRa vs. EtCO2 for Respiratory Pause
Detection
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Data retrospectively analyzed from PACU and General Floor monitoring episodes
Reference respiration rate determined by expert observer throughout each monitoring episode
Respiratory pause defined as 30 seconds with no breathing activity
86 monitoring episodes of respiratory pause identified
Sensitivity and specificity of Oridion Capnostream and Rainbow Acoustic Monitoring determined
Sensitivity
Oridion
Capnostream
Masimo
Rainbow Acoustic
Monitoring
v7706
39%
71%
98%
96%
(respiratory pause detected when actual respiratory pause
occurs)
Specificity
(no respiratory pause indicated when no actual respiratory
pause exists)
Internal Masimo Data
Masimo Rainbow Pulse CO-Oximetry and
Rainbow Acoustic Monitoring
Allow you to noninvasively and continuously monitor key
indicators of:
Oxygenation (SpO2)
Ventilation (RRa™)
Circulation (PR)
Bleeding (SpHb™)
• Helping you meet APSF guidelines for monitoring post-operative patients
• Offering a breakthrough in patient safety for post-surgical patients on the general floor
• Monitor More Patients, More Safely Than Ever Before
Rainbow Acoustic Monitoring
Clinical Applications
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General Care Floor with or without PSN
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Any patient on Pain Management drugs (opioids)
All patients on PCA pumps
All OSA patients
All bariatric patients
• Conscious Sedation Procedures (endoscopy, bronchoscopy)
• PACU Patients
• Patients currently continuously monitored with impedance
pneumography where respiration rate is more important than
ECG monitoring
Rainbow Acoustic Monitoring Devices
Clinical Samples
-- RRa - RAM -- RR - EtCo2-- SpO2
-- RRa - RAM -- RR - EtCo2-- SpO2
-- RRa - RAM -- RR - EtCo2-- SpO2
-- RRa - RAM -- RR - EtCo2-- SpO2
-- RRa - RAM -- RR - EtCo2-- SpO2
-- RRa - RAM -- RR - EtCo2-- SpO2
-- RRa - RAM -- RR - EtCo2-- SpO2
-- RRa - RAM -- RR - EtCo2-- SpO2
Patient with desaturations and multiple respiratory pauses