Estimation of airway obstruction using oximeter plethysmograph waveform data

biomed - Spiro , Desmond , Arnold , Hagood

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8 pages

English

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Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results There were significant relationships between maximal change in area under the curve (P < .0001) or height (P < 0.0001) and mouth pressure. Conclusion The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.

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Publié par	biomed
Publié le	01 janvier 2005
Nombre de lectures	100
Langue	English

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Respiratory Research

BioMedCentral

Open Access Research Estimation of airway obstruction using oximeter plethysmograph waveform data 1 †2 †3 Donald H Arnold* , David M Spiro , Renee' A Desmond and †4 James S Hagood

1 2 Address: Departments of Emergency Medicine and Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA, Department 3 of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA, Department of Medicine, The 4 University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA and Department of Pediatrics, Division of Pulmonary Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA Email: Donald H Arnold*  don.arnold@vanderbilt.edu; David M Spiro  david.spiro@yale.edu; Renee' A Desmond  desmond@uab.edu; James S Hagood  jhagood@peds.uab.edu * Corresponding author †Equal contributors

Published: 28 June 2005 Received: 18 April 2005 Accepted: 28 June 2005 Respiratory Research2005,6:65 doi:10.1186/1465-9921-6-65 This article is available from: http://respiratory-research.com/content/6/1/65 © 2005 Arnold et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background:Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods:Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results:There were significant relationships between maximal change in area under the curve (P < .0001) or height (P < 0.0001) and mouth pressure.

Conclusion:The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.

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