Abnormal Breathing Patterns

Cheyen-Stokes:

• This breathing pattern is characterized by periods of respirations during which the spontaneous tidal volume starts shallow and progressively gets deeper with each breathe, then gets progressively more shallow with each breathe. This is followed by a period of apnea that can last anywhere from 15 seconds to 120 seconds. This cycle is repeated over and over.
• Causes: Cheyen-Stokes breathing is often caused by strokes, traumatic brain injuries, brain tumors, carbon dioxide poisoning, and metabolic encephalopathy. This pattern can also be seen in healthy patients experiencing first-time high altitude sickness, and can also be a normal side effect of IV morphine administration.

Biot's Breathing (aka "Cluster" breathing):

• Biot's breathing is characterized by periods, or "clusters", of fairly rapid respirations of close to equal depth followed by reular periods of apnea that can last between 15 seconds to 120 seconds. Biot's breathing is very imilar to Cheyen-Stokes except the spontaneous tidal volume is equal throughout the period of respiration.
• Causes: Biot's breathing is usually caused by damage to the medulla oblongata by stroke (CVA) or trauma, or pressure on the medulla due to uncal or tenorial herniation. Biot's breathing can also be caused by prolonged opioid abuse.

Kussmaul's Breathing:

• Labored hyperventilation characterized by a deep and rapid respiratory pattern.
• Causes: This type of labored hyperventilation is usually seen in the late stages of a severe metabolic acidosis. An example would be an acute diabetic ketoacidosis (DKA). The patient becomes "air hungry" and the desperate gasping characteristic of Kussmaul's breathing almost appears involuntary. Most of the time a respiratory pattern secondary to a metabolic acidosis is rapid and shallow, and the true Kussmaul breathing pattern is rarely seen because the acidosis is often corrected before the patient reaches that stage of the condition.

Apneustic Breathing:

• An apneustic breathing pattern has prolonged inspiratory phases with each breathe, followed by a prolonged expiratory phase that is often mistaken for an apneic period.
• Causes: Apneustic breathing is usually caused by damage to the upper part of the pons, which is the uppermost section of the brain stem. The pons contains, among other things, the "respiratory center" of the brain.

Ataxic Breathing:

• A completely irregular breathing pattern with irregular pauses and unpredictable periods of apnea. As breathing continues to deteriorate ataxic breathing begins to merge with agonal respirations.
• Ataxic breathing is usually cused by damage to the medulla oblongata secondary to trauma or stroke. This respiratory pattern indicates a very poor prognosis.