Respirations, shallow

Respirations are shallow when a diminished volume of air enters the lungs during inspiration. In an effort to obtain enough air, the patient with shallow respirations usually breathes at an accelerated rate. However, as he tires or as his muscles weaken, this compensatory increase in respirations diminishes, leading to inadequate gas exchange and such signs as dyspnea, cyanosis, confusion, agitation, loss of consciousness, and tachycardia.

Shallow respirations may develop suddenly or gradually and may last briefly or become chronic. They’re a key sign of respiratory distress and neurologic deterioration. Causes include inadequate central respiratory control over breathing, neuromuscular disorders, increased resistance to airflow into the lungs, respiratory muscle fatigue or weakness, voluntary alterations in breathing, decreased activity from prolonged bed rest, and pain.

Emergency interventions

If the patient is also wheezing, check for stridor, nasal flaring, and accessory muscle use. Administer oxygen with a face mask or handheld resuscitation bag. Attempt to calm the patient. Administer epinephrine I.V.

If the patient loses consciousness, insert an artificial airway and prepare for endotracheal intubation and ventilatory support. Measure his tidal volume and minute volume with a Wright respirometer to determine the need for mechanical ventilation. (See Measuring lung volumes, page 538.) Check arterial blood gas (ABG) levels, heart rate, blood pressure, and oxygen saturation. Tachycardia, increased or decreased blood pressure, poor minute volume, and deteriorating ABG levels or oxygen saturation signal the need for intubation and mechanical ventilation.

History and physical examination

If the patient isn’t in severe respiratory distress, begin with the history. Ask about chronic illness and surgery or trauma. Has he had a tetanus booster in the past 10 years? Does he have asthma, allergies, or a history of heart failure or vascular disease? Does he have a chronic respiratory disorder or respiratory tract infection, tuberculosis, or a neurologic or neuromuscular disease? Does he smoke? Obtain a drug history as well, and explore the possibility of drug abuse.

Ask about the patient’s shallow respirations: When did they begin? How long do they last? What makes them subside? What aggravates them? Ask about changes in appetite, weight, activity level, and behavior.

Begin the physical examination by assessing the patient’s level of consciousness (LOC) and his orientation to time, person, and place. Observe spontaneous movements, and test muscle strength and deep tendon reflexes. Next, inspect the chest for deformities or abnormal movements such as intercostal retractions. Inspect the extremities for cyanosis and digital clubbing.

Now, palpate for expansion and diaphragmatic tactile fremitus, and percuss for hyperresonance or dullness. Auscultate for diminished, absent, or adventitious breath sounds and for abnormal or distant heart sounds. Do you note peripheral edema? Finally, examine the abdomen for distention, tenderness, or masses.

Medical causes

Acute respiratory distress syndrome (ARDS)

Initially, ARDS produces rapid, shallow respirations and dyspnea. Hypoxemia leads to intercostal and suprasternal retractions, diaphoresis, and fluid accumulation, causing rhonchi and crackles. As hypoxemia worsens, the patient exhibits more difficulty breathing, restlessness, apprehension, a decreased LOC, cyanosis and, possibly, tachycardia.

Amyotrophic lateral sclerosis (ALS)

Respiratory muscle weakness in ALS causes progressive shallow respirations. Exertion may result in increased weakness and respiratory distress. ALS initially produces upper extremity muscle weakness and wasting, which in several years affect the trunk, neck, tongue, and muscles of the larynx, pharynx, and lower extremities. Associated signs and symptoms include muscle cramps and atrophy, hyperreflexia, slight spasticity of the legs, coarse fasciculations of the affected muscle, impaired speech, and difficulty chewing and swallowing.

Asthma

With asthma, bronchospasm and hyperinflation of the lungs cause rapid, shallow respirations. In adults, mild persistent signs and symptoms may worsen during severe attacks. Related respiratory effects include wheezing, rhonchi, a dry cough, dyspnea, prolonged expirations, intercostal and supraclavicular retractions on inspiration, nasal flaring, and accessory muscle use. Chest tightness, tachycardia, diaphoresis, and flushing or cyanosis may occur.

Atelectasis

Decreased lung expansion or pleuritic pain causes a sudden onset of rapid, shallow respirations. Other signs and symptoms include a dry cough, dyspnea, tachycardia, anxiety, cyanosis, and diaphoresis. Examination reveals dullness to percussion, decreased breath sounds and vocal fremitus, inspiratory lag, and substernal or intercostal retractions.

Bronchiectasis

Increased secretions obstruct airflow in the lungs, leading to shallow respirations and a productive cough with copious, foul-smelling, mucopurulent sputum (a classic finding). Other findings include hemoptysis, wheezing, rhonchi, coarse crackles during inspiration, and late-stage clubbing. The patient may complain of weight loss, fatigue, exertional weakness and dyspnea on exertion, a fever, malaise, and halitosis.

Coma

Rapid, shallow respirations result from neurologic dysfunction or restricted chest movement.

Emphysema

Increased breathing effort causes muscle fatigue, leading to chronic shallow respirations. The patient may also display dyspnea, anorexia, malaise, tachypnea, diminished breath sounds, cyanosis, pursed-lip breathing, accessory muscle use, barrel chest, a chronic productive cough, and clubbing (a late sign).

Flail chest

With flail chest, decreased air movement results in rapid, shallow respirations, paradoxical chest wall motion from rib instability, tachycardia, hypotension, ecchymoses, cyanosis, and pain over the affected area.

Guillain-Barré syndrome

Progressive ascending paralysis causes a rapid or progressive onset of shallow respirations. Muscle weakness begins in the lower limbs and extends finally to the face. Associated findings include paresthesia, dysarthria, a diminished or an absent corneal reflex, nasal speech, dysphagia, ipsilateral loss of facial muscle control, and flaccid paralysis.

Multiple sclerosis

Muscle weakness causes progressive shallow respirations. Early features include diplopia, blurred vision, and paresthesia. Other possible findings are nystagmus, constipation, paralysis, spasticity, hyperreflexia, intention tremor, an ataxic gait, dysphagia, dysarthria, urinary dysfunction, impotence, and emotional lability.

Myasthenia gravis

Progression of myasthenia gravis causes respiratory muscle weakness marked by shallow respirations, dyspnea, and cyanosis. Other effects include fatigue, weak eye closure, ptosis, diplopia, and difficulty chewing and swallowing.

Pleural effusion

With pleural effusion, restricted lung expansion causes shallow respirations, beginning suddenly or gradually. Other findings include a nonproductive cough, weight loss, dyspnea, and pleuritic chest pain. Examination reveals a pleural friction rub, tachycardia, tachypnea, decreased chest motion, flatness to percussion, egophony, decreased or absent breath sounds, and decreased tactile fremitus.

Pneumothorax

Pneumothorax causes a sudden onset of shallow respirations and dyspnea. Related effects include tachycardia; tachypnea; sudden sharp, severe chest pain (commonly unilateral) that worsens with movement; a nonproductive cough; cyanosis; accessory muscle use; asymmetrical chest expansion; anxiety; restlessness; hyperresonance or tympany on the affected side; subcutaneous crepitation; decreased vocal fremitus; and diminished or absent breath sounds on the affected side.

Pulmonary edema

Pulmonary vascular congestion causes rapid, shallow respirations. Early signs and symptoms include exertional dyspnea, paroxysmal nocturnal dyspnea, a nonproductive cough, tachycardia, tachypnea, dependent crackles, and a ventricular gallop. Severe pulmonary edema produces more rapid, labored respirations; widespread crackles; a productive cough with frothy, bloody sputum; worsening tachycardia; arrhythmias; cold, clammy skin; cyanosis; hypotension; and a thready pulse.

Pulmonary embolism

Pulmonary embolism causes sudden, rapid, shallow respirations and severe dyspnea with angina or pleuritic chest pain. Other clinical features include tachycardia, tachypnea, a nonproductive cough or a productive cough with blood-tinged sputum, a low-grade fever, restlessness, diaphoresis, a pleural friction rub, crackles, diffuse wheezing, dullness to percussion, decreased breath sounds, and signs of circulatory collapse. Less-common findings are massive hemoptysis, chest splinting, leg edema, and (with a large embolism) cyanosis, syncope, and jugular vein distention.

Other causes

Drugs

Opioids, sedatives and hypnotics, tranquilizers, neuromuscular blockers, magnesium sulfate, and anesthetics can produce slow, shallow respirations.

Surgery

After abdominal or thoracic surgery, pain associated with chest splinting and decreased chest wall motion may cause shallow respirations.

Special considerations

Prepare the patient for diagnostic tests: ABG analysis, pulmonary function tests, chest X-rays, or bronchoscopy.

Position the patient as nearly upright as possible to ease his breathing. (Help a postoperative patient splint his incision while coughing.) If he’s taking a drug that depresses respirations, follow all precautions, and monitor him closely. Ensure adequate hydration, and use humidification as needed to thin secretions and to relieve inflamed, dry, or irritated airway mucosa. Administer humidified oxygen, a bronchodilator, a mucolytic, an expectorant, or an antibiotic, as ordered. Perform tracheal suctioning, as needed, to clear secretions.

Turn the patient frequently. He may require chest physiotherapy, incentive spirometry, or intermittent positive-pressure breathing. Monitor the patient for increasing lethargy, which may indicate rising carbon dioxide levels. Have emergency equipment at the patient’s bedside.

Pediatric pointers

In children, shallow respirations commonly indicate a life-threatening condition. Airway obstruction can occur rapidly because of narrow passageways; if it does, administer back blows or chest thrusts but not abdominal thrusts, which can damage internal organs.

Causes of shallow respirations in infants and children include idiopathic (infant) respiratory distress syndrome, acute epiglottiditis, diphtheria, aspiration of a foreign body, croup, acute bronchiolitis, cystic fibrosis, and bacterial pneumonia.

Observe the child to detect apnea. As needed, use humidification and suction, and administer supplemental oxygen. Give parenteral fluids to ensure adequate hydration. Chest physiotherapy and postural drainage may be required.

Geriatric pointers

Stiffness or deformity of the chest wall associated with aging may cause shallow respirations.

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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.

Other Book Chapters Related to Rapid breathing

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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Rapid breathing

• Back to symptom: Rapid breathing: Introduction (review 336 causes)
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More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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