Post-inspiratory, post-expiratory breath
- Apneustic respiration (a.k.a. apneusis) is an abnormal pattern of
breathing characterized by deep, gasping inspiration with a pause at full
inspiration followed by a brief, insufficient release. It is caused by damage to
the pons or upper medulla caused by strokes or trauma. Specifically, concurrent
removal of input from the vagus nerve and the pneumotaxic center causes this
pattern of breathing. It is an ominous sign, with a generally poor prognosis.
pontine lesion. It can also be temporarily caused by some drugs, such as
ketamine.
- Bradypnea frequency reduction (<7 reduction --8 acts / minute).
Bradypnea or bradypnoea is abnormally slow breathing. The respiratory rate at
which bradypnea is diagnosed depends on the age of the patient. The cause are:
Degeneration of heart tissue because of aging - Damage to tissues in the heart
from heart attack or heart disease- High blood pressure or hypertension-
Congenital heart defect which is disorder present at birth - Heart tissue
infection also known as myocarditis -Complication of heart surgery-
Hypothyroidism or underactive thyroid gland- Imbalance of electrolytes which are
mineral related substances needed for conducting electrical impulses-
Obstructive sleep apnea which is the repeated disruption of breathing during
sleep.- Inflammatory disease, such as lupus or rheumatic fever
- Tachypnea frequency increase (> 20 acts / minute). Tachypnea or
tachypnoea is abnormally rapid breathing. In adult humans at rest, any
respiratory rate between 12 and 20 breaths per minute is normal and tachypnea is
indicated by a rate greater than 20 breaths per minute.[1] Children have
significantly higher resting ventilatory rates, which decline rapidly during the
first three years of life and then steadily until around 18 years. Tachypnea can
be an early medical sign of pneumonia in children.
Amongst pathophysiological causes of tachypnea they can be a symptom of sepsis,
compensation for diabetic ketoacidosis or other metabolic acidosis, pneumonia,
pleural effusion, carbon monoxide poisoning, pulmonary embolism, asthma, COPD,
laryngospasm, allergic reaction causing airway edema, foreign body aspiration,
tracheobronchomalacia, congestive heart failure, anxiety states, or many other
medical issues.
- Hyperpnea increase in amplitude current volume (> 500 ml).
Hyperpnea or hyperpnoea is increased depth and rate of breathing. It may be
physiologic, as when required to meet metabolic demand of body tissues (for
example, during or after exercise, or when the body lacks oxygen at high
altitude or as a result of anemia), or it may be pathologic, as when sepsis is
severe.
- Polypnea minute ventilation (hyperventilation)
1) Kussmaul's Breath (gasping, deep and slow): Metabolic acidosis . Graph showing the Kussmaul breathing and other pathological breathing patterns. Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration. In metabolic acidosis, breathing is first rapid and shallow[ but as acidosis worsens, breathing gradually becomes deep, labored and gasping. It is this latter type of breathing pattern that is referred to as Kussmaul breathing.
2) Breath of Biot (apneas and regular breaths): Meningitis, severe
Cerebropathies . Biot's respiration is an abnormal pattern of breathing
characterized by groups of quick, shallow inspirations followed by regular or
irregular periods of apnea
3) Breath of Cheyne Cheyne-Stokes (periodic breath): depression and phase
displacement
respiratory centers [uremia, heart failure, cerebral haemorrhages] .Cheyne-Stokes
respiration is an abnormal pattern of breathing characterized by
progressively deeper, and sometimes faster, breathing followed by a gradual
decrease that results in a temporary stop in breathing called an apnea. The
pattern repeats, with each cycle usually taking 30 seconds to 2 minutes.
Cerebral edema.
Many and varied factors can partially or completely depress the activity of the
respiratory center. One of the most frequent among these is cerebral edema,
resulting in commotion. For example, as a result of head injury, the brain
tissue may undergo tumefaction and compress the cerebral arteries against the
cranial walls, completely or partially blocking the blood flow. Consequently the
neurons of the respiratory center become inactive and therefore die. In this way
the cerebral edema can depress or completely inactivate the respiratory center.
Sometimes the respiratory depression produced by edema can be cured by
intravenous injections of hypertonic solutions, which remove osmotic part of the
intracellular fluid of the brain, thus relieving the intracranial pressure and
sometimes restoring the breathing within a few minutes.
Pressure cone
A particular condition that often occurs in intracranial lesions and in
intracranial tumors is the one known as a "pressure cone". That is to say, the
pressure of the cranial vault pushes the encephalous down against the large
foramen, compressing the upper and thickest part of the bulb against the foramen
itself. It follows that i! blood flow into the bulb is reduced or ceases
altogether, so that the activity of the respiratory center decreases or stops
completely. Many patients with brain tumors die suddenly because of such a
situation. This, sometimes, can occur following the removal of liquor, in
subjects with high endorachoid pressure, since, as soon as the liquid is removed
from the spine, that of the skull vault pushes the bulb against the large
foramen and the patient dies in a few minutes .
Abnormal breath scheme of Cheyne-Stokes, Kusmaull, Biot
Anesthesia.
Among the different causes of depression or respiratory arrest, the most
frequent is the excessive dosage of anesthetics or narcotics. In the use of
anesthetics, the choice must always fall between those whose depressing effect
is minimal at the level of the respiratory center and maximum at the level of
the cerebral cortex. An anesthetic of this type completely blocks the cortical
structures of the consciousness, without however disturbing the respiratory
automatism. From this point of view, ether is perhaps the best of anesthetics,
although the halothane, cyclopropane, ethylene, nitrous oxide and a few others
have almost the same advantages. On the other hand, sodium pentobarbital is a
mediocre anesthetic, since it depresses the respiratory center much more than
the aforementioned anesthetics. In the past, morphine was widely used as an
anesthetic, but because it strongly depresses the respiratory center, it is now
used only in addition to other anesthetics.
Stimulants for the treatment of respiratory depression.
Some medications, such as picrotossin and cardiazol, directly excite the
respiratory center and can, to some extent, counterbalance the depressive
effects of anesthetics or narcotics and neuronal lesions. Coramine is another
drug that, though indirectly, activates respiration. In fact, this drug acts on
the carotid and aortic chemoreceptors, which in turn excite the respiratory
center. Similarly, caffeine, benzedrine, theophylline and many other stimulants
of the central nervous system can be useful against the depression of the
respiratory center.