Respiratory patterns

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Respiratory Patterns
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Overview

Classification

Eupnea
Tachypnea
Bradypnea
Apnea
Cheyne-Stokes Respiration
Biot's Respiration
Apneustic Respiration
Agonal Respiration
Kussmaul's Respiration
Sighing Respiration

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Synonyms and keywords:

Overview

Classification

Eupnea

Normal respiratory rate in every age group is as following:

Age group Normal respiratory rate (Breath number per minute)
Infants 30 to 60
1 to 3 years 24 to 40
3 to 6 years 22 to 34
6 to 12 years 18 to 30
12 to 18 years 12 to 16

Tachypnea

  • Tachypnea is increased rate and decrease depth of breathing.
The main pathophysiology of tachypnea is as following:
 
 
 
 
 
 
 
Decreased plasma oxygen (hypoxemia)
 
Increased plasma CO2
(respiratory acidosis)
 
Decreased pulmonary compliance
 
Increased airway resistance
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Carotid body
 
Medullary chemoreceptors
 
Pulmonary or muscle mechanoreceptors
 
Airway receptors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tachypnea
 
 
 
 
 
 
 

The main causes of tachypnea are classified into pulmonary, cardiovascular, hematologic, and metabolic pathophysiologies.

Causes Other findings
Pulmonary Asthma
Chronic obstructive pulmonary disease (COPD)
Pneumonia
Congestive heart failure (CHF)
Pneumothorax
Cardiovascular Pericardial effusion
Cardiac Tamponade
Pulmonary embolism
Myocardial infarct
  • Inverted T-wave or depressed/elevated ST-segment
  • Local or generalized wall motion abnormality
Hematologic Anemia
Sickle cell disease
Metabolic Metabolic acidosis
Diabetic ketoacidosis (DKA)

Bradypnea

Causes Other
Drugs Opioids Heroin Can become worse when used along with:
Codeine
Hydrocodone
Morphine
Oxycodone
Toxins Sodium azide
  • Found in automobile airbags
Carbon monoxide
  • Produced from oil or gas furnaces
  • Absorbed by lungs and decrease the blood oxygen level
Other drugs Sedatives
Anesthetics
Systemic disease Lung diseases Emphysema -
Chronic bronchitis
Severe asthma
Pneumonia
Pulmonary edema
Thyroid Hypothyroidism -
Neuromuscular Guillain-Barré syndrome
Amyotrophic lateral sclerosis (ALS)

Apnea

 
 
 
 
 
 
 
 
 
 
 
 
 
Apnea
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sleep disturbances
 
 
 
 
 
 
 
 
 
 
 
 
 
O2, ↑CO2, ↓pH
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Excessive motor activity
 
Loss of deep sleep
Sleep fragmentation
 
Brain malfunction
 
Severe CO2 retention
 
Systemic vasoconstriction
 
Pulmonary vasoconstriction
 
Vagal bradycardia
Ectopic cardiac pulses
 
Decreased pulmonary pressure
Increased cardiac afterload
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Restless sleep
 
 
 
Excessive daytime fatigue
 
 
 
Chronic hypoventilation
 
Systemic hypertension
 
Pulmonary hypertension
 
Unexplained nocturnal death
 
Left heart failure
 
 
 
 
 
 
 
 
Intellectual deterioration
 
 
 
 
 
 
 
 
 
 
 
Right heart failure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Personality change
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Behavioral disorder
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Cheyne-Stokes Respiration

The main pathophysiology of Cheyne-Stokes respiration pattern is as following:[3]


 
Hypoxemia
 
Pulmonary vein congestion
 
Pulmonary C fibers stimulation
 
Spontaneous arousal
 
Increased circulating noradrenaline
 
Decreased cardiac output
 
Increased cardiac chamber size
 
Increased blood volume
 
Hyperventilation during day and night
 
Restrictive ventilatory defect
 
Decreased CO2 transfer capacity
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peripheral chemoreceptor stimulation
 
 
 
Increased pulmonary vagal efferent activity
 
 
 
 
 
Increased sympathetic activity
 
 
 
 
 
 
 
Circulatory delay
 
 
 
 
 
Decreased total body CO2
 
Decreased total body O2
 
Increased pulmonary capillary wedge pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperventilation
 
 
 
 
 
 
 
 
 
 
 
 
Length of the apnea-hyperpnea cycle
 
 
 
Crescendo-decrescendo respiratory pattern
 
 
 
 
 
 
Decreased blood gas buffering capacity
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cheyne-Stokes respiration
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Biot's Respiration

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  • Camille Biot, in 1878 distinguished Biot's respiration from Cheyne-Stokes, named it “rhythme meningitique”.
  • Biot's respiration is a kind of slow respiration pattern with periodic increasing 10-20 respiration per minute, without crescendo–decrescendo pattern.
  • Accelerations are different in a patient with Biot's respiration:[4]
    • Short and incomplete
    • Long and deep
    • Often interrupted by gasps
  • The periods are different in length, ended to a sigh just before the pause.
  • The main causes of Biot's respiration include:




Apneustic Respiration

Agonal Respiration

Shallow Respiration

Hyperpnea

Air Trapping

Kussmaul's Respiration

Sighing Respiration

References

  1. Leung, Alexander K. C.; Schmitt, Marcus; Thomas, Christie P.; Sunderkötter, Cord; Schiller, Meinhard; Schwarz, Thomas; Berneburg, Mark; Kohlschütter, Alfried; Cerroni, Lorenzo; Direskeneli, Haner; Calamia, Kenneth; David, Gloria L.; Zeldin, Darryl C.; Schütte, Bärbel; Denson, Lee A.; Erhardt, Andreas; Kubitz, Ralf; Häussinger, Dieter; Sealey, Wendy M.; Mock, Donald M.; Wolf, Barry; Schumacher, Johannes; Propping, Peter; Metze, Dieter; Leung, Alexander K. C.; Wong, Andrew L.; Berneburg, Mark; Schwarz, Thomas; Hengstschläger, Markus; High, Whitney A.; Shroyer, Kenneth R.; McCready, M. Elizabeth; Bulman, Dennis E.; Afzal, Ali R.; Everman, David B.; Stoll, Claude; Darcan, Sukran; Kou, Yu Ru; Lin, You Shuei; Suzuki, Yoichi; Tada, Keiya; Leung, Alexander K. C.; Kupka, Susan; Dietmaier, Wolfgang; Hartmann, Arndt; Hennekam, Raoul C. M.; Belperio, John A.; Keane, Michael P.; Smith, M. Iain; Strieter, Robert M.; Molfino, Nestor A.; Sciandra, Francesca; Rossenbacker, Tom; Priori, Silvia G.; Senzolo, Marco; Triantos, Christos; Samonakis, Dimitrios; Cholongitas, Evangelos; Burroughs, Andrew K.; Mura, Marco; Braun-Falco, Markus; Hofmann, Silke; Bruckner-Tuderman, Leena (2009). "Bradypnea": 241–243. doi:10.1007/978-3-540-29676-8_246.
  2. Hanly PJ, Zuberi-Khokhar NS (January 1996). "Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure". Am. J. Respir. Crit. Care Med. 153 (1): 272–6. doi:10.1164/ajrccm.153.1.8542128. PMID 8542128.
  3. Naughton, M T (1998). "Pathophysiology and treatment of Cheyne-Stokes respiration". Thorax. 53 (6): 514–518. doi:10.1136/thx.53.6.514. ISSN 0040-6376.
  4. Wijdicks, E. F M (2006). "Biot's breathing". Journal of Neurology, Neurosurgery & Psychiatry. 78 (5): 512–513. doi:10.1136/jnnp.2006.104919. ISSN 0022-3050.