Respiratory Care
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Monitoring oxygenation and ventilation throughout the breathing cycle helps provide a more complete picture of a patient's respiratory status.
Oxygenation
Masimo’s first breakthrough technology, Signal Extraction Technology® (SET®), overcame the limitations of conventional pulse oximetry with the ability to measure through motion and low perfusion.1 Masimo SET® uses parallel signal processing, whereas conventional pulse oximetry uses the standard red over infrared algorithm to provide oxygen saturation (SpO2). SET® has the ability to distinguish between arterial signal and venous noise during motion and low perfusion by identifying and isolating the non-arterial and venous noise SpO2 from the true arterial SpO2 components in the signal.
Two separate studies found that Masimo SET® pulse oximeters detected approximately 10 times more true events than other “Next Generation” pulse oximeters studied.2,3 Additionally, in another study comparing the ability of three pulse oximetry technologies to detect hypoxic events, Masimo SET® pulse oximetry demonstrated the highest sensitivity and specificity during induced conditions of motion and low perfusion.1
Performance During Motion and Low Perfusion1
Masimo SET® had 3% missed true alarms and 5% false alarms versus 43% and 28%, respectively, using competitor technology.1
Results shown are calculated by combining sensitivity and specificity outcomes of the machine-generated and volunteer-generated motion.
While Masimo pulse oximeters offer SET® SpO2 and pulse rate (PR), Masimo Pulse CO-Oximeters® offer additional measurement capability, including total hemoglobin (SpHb®) and dyshemoglobins, expanding visibility into a patient’s oxygenation status.
Ventilation
Capnography is a noninvasive monitoring technique that allows fast and reliable insight into ventilation, circulation, and metabolism. When used together, capnography and pulse oximetry are useful in weaning patients from mechanical ventilation.4 In addition, capnography also facilitates monitoring of spontaneous ventilation after weaning and during sedation procedures.4,5 A 2017 meta-analysis of sedation-related adverse events found that the inclusion of capnography monitoring resulted in a reduction in respiratory compromise during procedural sedation and analgesia compared to visual assessment and SpO2 alone.6
The Anesthesia Patient Safety Foundation (APSF) states that continuous electronic monitoring of oxygenation and ventilation should be available and considered for all patients during the post-operative period, to reduce the likelihood of unrecognized clinically significant opioid-induced depression of ventilation.7
In situations requiring intubation, capnography has long played a role in confirming proper endotracheal tube placement and, in both elective and emergency intubations, end tidal carbon dioxide (EtCO2) measurement is a standard of care for confirming endotracheal intubation.8 In addition, EtCO2 provides a noninvasive estimate of the partial pressure of carbon dioxide (PaCO2) and insight into a patient’s breathing rate and pattern before extubation.8
Innovations in Respiration Rate Monitoring—rainbow Acoustic Monitoring®
The Anesthesia Patient Safety Foundation (APSF) and The Joint Commission recommend continuous oxygenation and/or ventilation monitoring for patients receiving opioid-based pain medications.9,10 However, current methods of respiration rate monitoring may be limited by accuracy and patient tolerance.11,12 rainbow Acoustic Monitoring provides a noninvasive, continuous, easy-to-use, and reliable monitoring solution that has the benefit of higher patient compliance.13,14 Additionally, continuous monitoring of SpO2 and acoustic respiration rate (RRa®), as well as other physiologic parameters, on a single Masimo Pulse CO-Oximeter® facilitates well-rounded patient assessment and provides clinicians with more data to make informed care decisions.
How it Works
A Respiratory Acoustic Sensor, such as the RAS-45™ or RAS-125c, detects acoustic signals produced by the turbulent airflow in the upper airway that occurs during inhalation and exhalation, while signal processing algorithms convert the acoustic patterns into breath cycles to calculate respiratory rate. The respiratory signal is separated and processed to display continuous RRa measurements and waveforms, with the option to listen to the sound of breathing from the acoustic sensor. While Masimo offers capnography solutions, rainbow Acoustic Monitoring may be better suited for post-surgical monitoring and conscious sedation.
Masimo Portfolio
Masimo offers a complete portfolio of oxygenation and capnography solutions with industry-leading pulse oximetry and CO-Oximetry technologies and both sidestream and mainstream capnography options. These solutions meet the challenges of alveolar ventilation monitoring in virtually all care areas, including pre-hospital, in-hospital, transport, long-term care, ambulatory care centers and clinics, physician and dental offices, and home care. Solutions range from integrated OEM offerings, to external “plug in and measure” gas analyzers, to bedside and handheld devices.
Rad-97™ with NomoLine™ Capnography, Rad-97, Rad-97 with Noninvasive Blood Pressure, Root® with ISA™ CO2, MightySat™ Rx, EMMA™ Capnograph, NomoLine Sampling Lines, RAS-45 Sensor
NomoLine Sampling Lines
NomoLine technology eliminates common problems associated with conventional sidestream gas analysis. Incorporating a unique, patented polymer, NomoLine allows water in the sampling line to evaporate into the surrounding air, while leaving oxygen, carbon dioxide, and anesthetic gases unaffected, eliminating the need for a water trap and issues related to their handling. Designed for low-flow applications, with functionality in any orientation, NomoLine sampling lines can be used in a variety of clinical scenarios on both intubated and non-intubated adult, pediatric, infant, and neonatal patients, in both low- and high-humidity applications.
Measurements
Respiratory Care Product Solutions
References:
- 1.
Shah et al. J Clin Anesth. 2012;24(5):385-91.
- 2.
Hay WW. Reliability of conventional and new oximetry in neonatal patients. J of Perinatol, 2002;22:360-36.
- 3.
Barker SJ. “Motion-Resistant” Pulse Oximetry: A comparison of new and old models. Anesth Analg. 2002;95(4):967-72.
- 4.
Capnography in Pediatrics. Bhavani Shankar Kodali MD. http://www.capnography.com/pediatrics. Sourced January 2018.
- 5.
Canography in Intensive Care Unit. Samuel M. Galvagno Jr., D.O., Bhavani Shankar Kodali, M.D.www.capnography.com. http://www.capnography.com/icu/capnography-in-icu sourced in January 2018
- 6.
Saunders, R., Struys, M. M. R. F., Pollock, R. F., Mestek, M., & Lightdale, J. R. (2017). Patient safety during procedural sedation using capnography monitoring: A systematic review and meta-analysis. BMJ Open, 7(6) doi:http://dx.doi.org/10.1136/bmjopen-2016-013402)
- 7.
“No Patient Shall Be Harmed By Opioid-Induced Respiratory Depression” [Proceedings of “Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period” Conference]. Volume 26, No. 2, 21-40. Retrieved from https://www.apsf.org/newsletters/pdf/fall_2011.pdf
- 8.
Nagler J et al. Emerg Med Clin North Am. 2008 Nov;26(4):881-97.
- 9.
Weinger MB, et al. APSF Newsletter. 2011;26(2):21-40.
- 10.
The Joint Commission Sentinel Event Alert. Issue 49, August 8, 2012. http://www.jointcommission.org/assets/1/18/ SEA_49_opioids_8_2_12_final.pdf
- 11.
Ramsay MAE et al. The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry. Anesth Analg. 2013 Jul;117(1):69-75
- 12.
Applegate RA et al. Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation: A 2-Part Pilot Trial. Anesth Analg. 2016;122(4):1070-8
- 13.
Macknet MR et al. Accuracy and Tolerance of a Novel Bioacoustic Respiratory Sensor in Pediatric Patients. Anesthesiology. 2007;107:A84. (abstract).
- 14.
Goudra BG et al. Comparison of Acoustic Respiration Rate, Impedance Pneumography and Capnometry Monitors for Respiration Rate Accuracy and Apnea Detection during GI Endoscopy Anesthesia. Open J Anesthesiol. 2013; 3:74-79
RESOURCES
For professional use. See instructions for use for full prescribing information, including indications, contraindications, warnings, and precautions.
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