Bradypnea

Commonly preceding life-threatening apnea or respiratory arrest, bradypnea is a pattern of regular respirations with a rate of fewer than 10 breaths/minute. This sign results from neurologic and metabolic disorders and drug overdose, which depress the brain's respiratory control centers. (See Understanding how the nervous system controls breathing.)

Emergency interventions

Depending on the degree of central nervous system (CNS) depression, the patient with severe bradypnea may require constant stimulation to breathe. If the patient seems excessively sleepy, try to arouse him by shaking and instructing him to breathe. Quickly take the patient's vital signs. Assess his neurologic status by checking pupil size and reactions and by evaluating his level of consciousness (LOC) and his ability to move his extremities.

Place the patient on an apnea monitor and pulse oximeter, keep emergency airway equipment available, and be prepared to assist with intubation and mechanical ventilation if spontaneous respirations cease. To prevent aspiration, position the patient on his side or keep his head elevated 30 degrees higher than the rest of his body, and clear his airway with suction or finger sweeps, if necessary. Administer opioid antagonists, as ordered.

History and physical examination

Obtain a brief history from the patient, if possible. Alternatively, obtain this information from whoever accompanied him to your facility. Ask if he's experiencing a drug overdose and, if so, try to determine what drugs he took, how much, when, and by what route. Check his arms for needle marks, indicating possible drug abuse. You may need to administer I.V. naloxone, a opioid antagonist.

If you rule out a drug overdose, ask about chronic illnesses, such as diabetes and renal failure. Check for a medical identification bracelet or an I.D. card that identifies an underlying condition. Also, ask whether the patient has a history of head trauma, brain tumor, neurologic infection, or stroke.

Medical causes

❑ Diabetic ketoacidosis. Bradypnea occurs late in patients with severe, uncontrolled diabetes. Patients with severe ketoacidosis may experience Kussmaul's respirations. Associated signs and symptoms include a decreased LOC, fatigue, weakness, a fruity breath odor, and oliguria.

❑ Hepatic failure. Occurring with end-stage hepatic failure, bradypnea may be accompanied by coma, hyperactive reflexes, asterixis, a positive Babinski's sign, fetor hepaticus, and other signs.

❑ Increased intracranial pressure (ICP). A late sign of increased ICP, a life-threatening condition, bradypnea is preceded by a decreased LOC, deteriorating motor function, and fixed, dilated pupils. The triad of bradypnea, bradycardia, and hypertension is a classic sign of late medullary strangulation.

❑ Renal failure. Occurring with end-stage renal failure, bradypnea may be accompanied by convulsions, a decreased LOC, GI bleeding, hypotension or hypertension, uremic frost, and diverse other signs.

❑ Respiratory failure. Bradypnea occurs with end-stage respiratory failure along with cyanosis, diminished breath sounds, tachycardia, mildly increased blood pressure, and a decreased LOC.

Other causes

❑ Drugs. Overdose with an opioid analgesic or, less commonly, a sedative, barbiturate, phenothiazine, or other CNS depressant can cause bradypnea. The use of any of these drugs with alcohol can also cause bradypnea.

Special considerations

Because a patient with bradypnea may develop apnea, check his respiratory status frequently and be prepared to give ventilatory support if necessary. Don't leave the patient unattended, especially if his LOC is decreased. Keep his bed in the lowest position and raise the side rails. Obtain blood for arterial blood gas analysis, electrolyte studies, and a possible drug screen. Ready the patient for chest X-rays and, possibly, a computed tomography scan of the head.

Administer prescribed drugs and oxygen. Avoid giving the patient a CNS depressant because it can exacerbate bradypnea. Similarly, give oxygen judiciously to a patient with chronic carbon dioxide retention, which may occur with chronic obstructive pulmonary disease, because excess oxygen therapy can decrease respiratory drive.

When dealing with slow breathing in hospitalized patients, always review all drugs and dosages given during the last 24 hours.

Pediatric pointers

Because respiratory rates are higher in children than in adults, bradypnea in children is defined according to age. (See Respiratory rates in children.)

Geriatric pointers

When drugs are prescribed for older patients, keep in mind that the elderly have a higher risk of developing bradypnea secondary to drug toxicity. That's because many of these patients take several drugs that can potentiate this effect and typically have other conditions that predispose them to it. Warn older patients about this potentially life-threatening complication.

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Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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