COMA-RESPIRATORY PATTERNS

SUMMARY

1. Cheyne-Stokes respiration: periods of hyperventilation alternating with apnea. Occurs in bilateral cerebral disease, impending herniation, and brainstem lesions; it can also be due to metabolic causes.

2. Apneustic breathing: series of slow, deep inspirations, each one held for 30sec or longer, after which the air is expelled by elastic recoil of the lungs, followed by an apneic pause. RR is ~ 1.5/min. It is due to a lesion of the lower pons.

3. Ataxic breathing: very irregular and typically indicates a lesion of the medulla.

4. Central neurogenic hyperventilation: lesions of the lower midbrain-upper pontine tegmentum cause central neurogenic hyperventilation, which produces an increase in the rate and depth of respiration resulting in advanced respiratory alkalosis.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].