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      A Comparison of Reflective Photoplethysmography for Detection of Heart Rate, Blood Oxygen Saturation, and Respiration Rate at Various Anatomical Locations

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          Abstract

          Monitoring of vital signs is critical for patient triage and management. Principal assessments of patient conditions include respiratory rate heart/pulse rate and blood oxygen saturation. However, these assessments are usually carried out with multiple sensors placed in different body locations. The aim of this paper is to identify a single location on the human anatomy whereby a single 1 cm × 1 cm non-invasive sensor could simultaneously measure heart rate (HR), blood oxygen saturation (SpO 2), and respiration rate (RR), at rest and while walking. To evaluate the best anatomical location, we analytically compared eight anatomical locations for photoplethysmography (PPG) sensors simultaneously acquired by a single microprocessor at rest and while walking, with a comparison to a commercial pulse oximeter and respiration rate ground truth. Our results show that the forehead produced the most accurate results for HR and SpO 2 both at rest and walking, however, it had poor RR results. The finger recorded similar results for HR and SpO 2, however, it had more accurate RR results. Overall, we found the finger to be the best location for measurement of all three parameters at rest; however, no site was identified as capable of measuring all parameters while walking.

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          Most cited references28

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          Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations.

          Pulse oximetry has revolutionized the ability to monitor oxygenation in a continuous, accurate, and non-invasive fashion. Despite its ubiquitous use, it is our impression and supported by studies that many providers do not know the basic principles behind its mechanism of function. This knowledge is important because it provides the conceptual basis of appreciating its limitations and recognizing when pulse oximeter readings may be erroneous. In this review, we discuss how pulse oximeters are able to distinguish oxygenated hemoglobin from deoxygenated hemoglobin and how they are able to recognize oxygen saturation only from the arterial compartment of blood. Based on these principles, we discuss the various conditions that can cause spurious readings and the mechanisms underlying them.
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            Photoplethysmographic derivation of respiratory rate: a review of relevant physiology.

            An abnormal respiratory rate is often the earliest sign of critical illness. A reliable estimate of respiratory rate is vital in the application of remote telemonitoring systems, which may facilitate early supported discharge from hospital or prompt recognition of physiological deterioration in high-risk patient groups. Traditional approaches use analysis of respiratory sinus arrhythmia from the electrocardiogram (ECG), but this phenomenon is predominantly limited to the young and healthy. Analysis of the photoplethysmogram (PPG) waveform offers an alternative means of non-invasive respiratory rate monitoring, but further development is required to enable reliable estimates. This review conceptualizes the challenge by discussing the effect of respiration on the PPG waveform and the key physiological mechanisms that underpin the derivation of respiratory rate from the PPG. Copyright © 2012 Informa UK, Ltd.
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              The light-tissue interaction of pulse oximetry.

              The underlying science of pulse oximetry is based on a simple manipulation of the Lambert-Beer law, which describes the attenuation of light traveling through a mixture of absorbers. Signals from detected red and infrared light that has traveled through blood-perfused tissues are used to estimate the underlying arterial hemoglobin oxygen saturation. However, light scatters in tissue and influences some of the simplifications made in determining this relationship. Under most clinical circumstances, the empirical process that manufacturers use to calibrate the system during its design readily accommodates this and results in accurate readings. The same tissue light scattering properties allow sensors to be configured for use on opposing or adjacent surfaces, provided that the placement sites offer sufficient signal strength and are absent factors known to influence accuracy. In this paper I review the light-tissue interaction in pulse oximetry and describe some of the assumptions made and their implications. Certain deviations from the nominal conditions, whether clinical in nature or misuse of the product, can affect system performance. Consequently, users should be cautious in modifying sensors and/or using them on tissue sites not intended by the manufacturer (off-label use). While perhaps helpful for obtaining pulsatile signals or extending the lifetime of a sensor, some practices can disrupt the optical integrity of the measurement and negatively impact the oxygen saturation reading accuracy.
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                Author and article information

                Journal
                Sensors (Basel)
                Sensors (Basel)
                sensors
                Sensors (Basel, Switzerland)
                MDPI
                1424-8220
                19 April 2019
                April 2019
                : 19
                : 8
                : 1874
                Affiliations
                [1 ]MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Milperra, NSW 2560, Australia; g.lui@ 123456westernsydney.edu.au (G.Y.L.); ganesh.naik@ 123456westernsydney.edu.au (G.N.); p.breen@ 123456westernsydney.edu.au (P.P.B.); G.Gargiulo@ 123456westernsydney.edu.au (G.D.G.)
                [2 ]Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
                [3 ]Ingham Institute of Applied Medical Research, University of New South Wales, Liverpool, NSW 2052, Australia; b.jalaludin@ 123456unsw.edu.au
                [4 ]Centre for Air Pollution, Energy and Health Research (CAR), Glebe, NSW 2037, Australia
                Author notes
                Author information
                https://orcid.org/0000-0002-5242-7028
                https://orcid.org/0000-0003-1042-5793
                https://orcid.org/0000-0003-1790-9838
                https://orcid.org/0000-0002-2616-2804
                Article
                sensors-19-01874
                10.3390/s19081874
                6514840
                31010184
                cc9bb5b0-dadd-4b3d-9450-aa31a5e687b2
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 March 2019
                : 17 April 2019
                Categories
                Article

                Biomedical engineering
                photoplethysmography,heart rate,spo2,respiration rate,anatomical location
                Biomedical engineering
                photoplethysmography, heart rate, spo2, respiration rate, anatomical location

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