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Apnea
Eupnea
Orthopnea
Only able to breathe comfortable in upright position (such as sitting in chair), unable to breath laying
down, (Or-thop-knee-a)
Dyspnea
Paroxysmal nocturnal dyspnea - attacks of severe shortness of breath that wakes a person from sleep,
such that they have to sit up to catch their breath - common in patient's with congestive heart failure.
Hyperpnea
Increased volume with or without and increased frequency (RR), normal blood gases present.
Hyperventilation
Figure 2-39 Hyperventilation. Increased rate (A) or depth (B), or combination of both.
"Over" ventilation - ventilation in excess of the body's need for CO 2 elimination. Results in a decreased
PaCO2, and a respiratory alkalosis.
Hypoventilation
"Under" ventilation - ventilation that is less than needed for CO 2 elimination, and inadequate to
maintain normal PaCO2. Results in respiratory acidosis.
Can be a slow rate with normal tidal volumes such that the total minute ventilation is inadequate.
Can be a normal rate but with such low tidal volumes that air exchange is only in the dead space and not effective.
Tachypnea
Kussmaul's Respiration
Kussmaul's respiration. Increased rate and depth of breathing over a prolonged period of time. In
response to metabolic acidosis, the body's attempt to blow off CO 2 to buffer a fixed acid such as
ketones. Ketoacidosis is seen in diabetics.
Gradual increase in volume and frequency, followed by a gradual decrease in volume and
frequency, with apnea periods of 10 - 30 seconds between cycle. Described as a crescendo -
decrescendo pattern. Characterized by cyclic waxing and waning ventilation with apnea gradually
giving way to hyperpneic breathing.
Seen with low cardiac output states (CHF) with compromised cerebral perfusion
Creates lag of CSF CO2 behind arterial PaCO2 and results in characteristic cycle. Delayed
sensitivity to CO2 changes- during apnea the CO2 increase above the threshold for stimulus but
the brain is slow to respond, then it over shoots by hyperventilating and the signal to reduce
ventilation is slow to be recognized.
Biot's respiration
Similar to CSR but VT is constant except during apneic periods. Short episodes of rapid, deep
inspirations followed by 10 - 30 second apneic period.
Persistent hyperventilation
May be caused by head trauma, severe brain hypoxia, or lack of cerebral perfusion
In traumatic brain injury (TBI), the brain swells acutely. Head is a fixed volume container - cannot
expand. When bleeding or swelling occurs in the brain pressures rapidly increase. Raising ICPs exceed
cerebral arterial pressure and brain perfusion stops.
Mechanical hyperventilation can lower PaCO2, which results in vasoconstriction in cerebral vessels,
reduction of swelling and ICP.