# Continuous Determination of Respiratory Rate in Hospitalized Patients using Machine Learning Applied to Electrocardiogram Telemetry

arXiv: https://arxiv.org/abs/2508.15947 · HTML: https://mlsanity.com/paper/2508.15947/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 31 references that are in the map.
- First posted on arXiv 21 Aug 2025.

## Builds on (most cited first, 12 of 12)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [A ConvNet for the 2020s](https://mlsanity.com/paper/2201.03545/) (2022)
- [Gaussian Error Linear Units (GELUs)](https://mlsanity.com/paper/1606.08415/) (2016)
- [Xception: Deep Learning with Depthwise Separable Convolutions](https://mlsanity.com/paper/1610.02357/) (2016)
- [Instance Normalization: The Missing Ingredient for Fast Stylization](https://mlsanity.com/paper/1607.08022/) (2016)
- [Mixed Precision Training](https://mlsanity.com/paper/1710.03740/) (2017)
- [CLOCS: Contrastive Learning of Cardiac Signals Across Space, Time, and Patients](https://mlsanity.com/paper/2005.13249/) (2020)
- [Automatic diagnosis of the 12-lead ECG using a deep neural network](https://mlsanity.com/paper/1904.01949/) (2019)
- [Large-scale Training of Foundation Models for Wearable Biosignals](https://mlsanity.com/paper/2312.05409/) (2023)
- [CardioLab: Laboratory Values Estimation from Electrocardiogram Features - An Exploratory Study](https://mlsanity.com/paper/2407.18629/) (2024)
- [Estimation of Cardiac and Non-cardiac Diagnosis from Electrocardiogram Features](https://mlsanity.com/paper/2408.17329/) (2024)
- [Unlocking Telemetry Potential: Self-Supervised Learning for Continuous Clinical Electrocardiogram Monitoring](https://mlsanity.com/paper/2406.16915/) (2024)

## Abstract (arXiv)

Respiration rate (RR) is an important vital sign for clinical monitoring of hospitalized patients, with changes in RR being strongly tied to changes in clinical status leading to adverse events. Human labels for RR, based on counting breaths, are known to be inaccurate and time consuming for medical staff. Automated monitoring of RR is in place for some patients, typically those in intensive care units (ICUs), but is absent for the majority of inpatients on standard medical wards who are still at risk for clinical deterioration. This work trains a neural network (NN) to label RR from electrocardiogram (ECG) telemetry waveforms, which like many biosignals, carry multiple signs of respiratory variation. The NN shows high accuracy on multiple validation sets (internal and external, same and different sources of RR labels), with mean absolute errors less than 1.78 breaths per minute (bpm) in the worst case. The clinical utility of such a technology is exemplified by performing a retrospective analysis of two patient cohorts that suffered adverse events including respiratory failure, showing that continuous RR monitoring could reveal dynamics that strongly tracked with intubation events. This work exemplifies the method of combining pre-existing telemetry monitoring systems and artificial intelligence (AI) to provide accurate, automated and scalable patient monitoring, all of which builds towards an AI-based hospital-wide early warning system (EWS).