Cheyne-Stokes respirations

The most common pattern of periodic breathing, Cheyne-Stokes respirations are characterized by a waxing and waning period of hyperpnea that alternates with a shorter period of apnea. This pattern can occur normally in patients with heart or lung disease. It usually indicates increased intracranial pressure (ICP) from a deep cerebral or brain stem lesion, or a metabolic disturbance in the brain.

Cheyne-Stokes respirations may indicate a major change in the patient's condition — usually a deterioration. For example, in a patient who has had head trauma or brain surgery, Cheyne-Stokes respirations may signal increasing ICP. Cheyne-Stokes respirations can occur normally in a patient who lives at high altitudes.

Emergency interventions

Time the periods of hyperpnea and apnea for 3 to 4 minutes to evaluate respirations and to obtain baseline data. Be alert for prolonged periods of apnea. Frequently check the patient's blood pressure; also check his skin color to detect signs of hypoxemia. Maintain airway patency and administer oxygen as needed. If the patient's condition worsens, endotracheal intubation is necessary.

History and physical examination

If the patient's condition permits, obtain a brief history. Ask especially about drug use.

Medical causes

Heart failure.

 With left-sided heart failure, Cheyne-Stokes respirations may occur with exertional dyspnea and orthopnea. Related findings include fatigue, weakness, tachycardia, tachypnea, and crackles. The patient may also have a cough, generally nonproductive but occasionally producing clear or blood-tinged sputum.

Hypertensive encephalopathy.

Hypertensive encephalopathy is a life-threatening disorder in which severe hypertension precedes Cheyne-Stokes respirations. The patient's LOC is decreased, and he may experience vomiting, seizures, severe headaches, vision disturbances (including transient blindness), or transient paralysis.

Increased ICP.

As ICP rises, Cheyne-Stokes respirations is the first irregular respiratory pattern to occur. It's preceded by a decreased LOC and accompanied by hypertension, headache, vomiting, impaired or unequal motor movement, and vision disturbances (blurring, diplopia, photophobia, and pupillary changes). In late stages of increased ICP, bradycardia and a widened pulse pressure occur.

Renal failure.

With end-stage chronic renal failure, Cheyne-Stokes respirations may occur in addition to bleeding gums, oral lesions, ammonia breath odor, and marked changes in every body system.

Other causes

Drugs.

 Large doses of an opioid, a hypnotic, or a barbiturate can precipitate Cheyne-Stokes respirations.

Special considerations

When evaluating Cheyne-Stokes respirations, be careful not to mistake periods of hypoventilation or decreased tidal volume for complete apnea.

Pediatric pointers

Cheyne-Stokes respirations rarely occur in children, except during late heart failure.

Geriatric pointers

Cheyne-Stokes respirations can occur normally in elderly patients during sleep.

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

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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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