Ataxic respiration

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Ataxic respirations
Other namesBiot's respiration; Biot's breathing
Biot's Breathing.jpg
Graph showing ataxic respirations and other pathological breathing patterns.
Specialty Neurology; Pulmonology
CausesDamage to Medulla Oblongata and Pons

Ataxic respirations, also known as Biot's respirations or Biot's breathing, is an abnormal pattern of breathing characterized by variable tidal volume, random apneas, and no regularity. [1] It is named for Camille Biot, who characterized it in 1876. [2] [3] Biot's respiration is caused by damage to the medulla oblongata and pons due to trauma, stroke, opioid use, and increased intracranial pressure due to uncal or tentorial herniation. [1] [4] Often this condition is also associated with meningitis. [2] In common medical practice, Biot's respiration is often mistaken for Cheyne–Stokes respiration, part of which may have been caused by them both being described by the same person and subtle differences between the types of breathing. [1] [3]

Contents

Ataxic respirations were discovered by Dr. Camille Biot in the late 19th century as he wrote multiple papers analyzing subtle differences in Cheyne-Stokes respirations in patients admitted to Hôtel Dieu Hospital. [5]

Etymology

The word ataxia is commonly used in the medical literature. Examining the word "taxis," meaning order or organization, and "a," meaning without, the resulting meaning is "without order" [6] . Hence, ataxic respirations should equate to respirations without order, which is accurate.

Etiology

Dr. Camille Biot- Founder of ataxic respirations Camille Biot.jpg
Dr. Camille Biot- Founder of ataxic respirations

Ataxic respirations are caused by damage to the medulla oblongata (respiratory center of the brainstem) due to strokes or trauma. It generally indicates a poor prognosis and usually progresses to complete apnea. [7]

Diagnosis and management

Advances in medical care may be masking the presence of ataxic respirations. This could be related to the fact that the treatment for ataxic respirations typically results in intubation immediately upon diagnosis, with mechanical ventilation to regulate patients' breathing. [5] Furthermore, patients will often be intubated and on mechanical ventilation prior to the onset of ataxic respirations. [5]

Various breathing abnormalities Breathing abnormalities.svg
Various breathing abnormalities

Ataxic respirations are one of many unique respiration styles in an ill patient. There is an apparent controversy surrounding the novelty of ataxic respirations versus the well-known Cheyne-Stokes and cluster respirations, which Dr. Camille Biot deemed mutually exclusive. [3] Notably, Dr. Miller Fisher was able to identify ataxic respirations in comatose patients differentiating the breathing from cluster breathing. [3]




Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few minutes and occurs many times a night. A choking or snorting sound may occur as breathing resumes. Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It is often a chronic condition.

Respiration may refer to:

<span class="mw-page-title-main">Medulla oblongata</span> Structure of the brain stem

The medulla oblongata or simply medulla is a long stem-like structure which makes up the lower part of the brainstem. It is anterior and partially inferior to the cerebellum. It is a cone-shaped neuronal mass responsible for autonomic (involuntary) functions, ranging from vomiting to sneezing. The medulla contains the cardiovascular center, the respiratory center, vomiting and vasomotor centers, responsible for the autonomic functions of breathing, heart rate and blood pressure as well as the sleep–wake cycle. "Medulla" is from Latin, ‘pith or marrow’. And "oblongata" is from Latin, ‘lengthened or longish or elongated'.

<span class="mw-page-title-main">Exhalation</span> Flow of the respiratory current out of an organism

Exhalation is the flow of the breath out of an organism. In animals, it is the movement of air from the lungs out of the airways, to the external environment during breathing. This happens due to elastic properties of the lungs, as well as the internal intercostal muscles which lower the rib cage and decrease thoracic volume. As the thoracic diaphragm relaxes during exhalation it causes the tissue it has depressed to rise superiorly and put pressure on the lungs to expel the air. During forced exhalation, as when blowing out a candle, expiratory muscles including the abdominal muscles and internal intercostal muscles generate abdominal and thoracic pressure, which forces air out of the lungs.

The control of ventilation is the physiological mechanisms involved in the control of breathing, which is the movement of air into and out of the lungs. Ventilation facilitates respiration. Respiration refers to the utilization of oxygen and balancing of carbon dioxide by the body as a whole, or by individual cells in cellular respiration.

<span class="mw-page-title-main">Cheyne–Stokes respiration</span> Abnormal breathing pattern

Cheyne–Stokes respiration is an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes. It is an oscillation of ventilation between apnea and hyperpnea with a crescendo-diminuendo pattern, and is associated with changing serum partial pressures of oxygen and carbon dioxide.

<span class="mw-page-title-main">Respiratory arrest</span> Medical condition

Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body. Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may permanently damage vital organs, especially the brain. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes.

<span class="mw-page-title-main">Central hypoventilation syndrome</span> Medical condition

Central hypoventilation syndrome (CHS) is a sleep-related breathing disorder that causes ineffective breathing, apnea, or respiratory arrest during sleep. CHS can either be congenital (CCHS) or acquired (ACHS) later in life. The condition can be fatal if untreated. CCHS was once known as Ondine's curse.

<span class="mw-page-title-main">Agonal respiration</span> Emergent abnormal pattern of breathing

Agonal respiration, gasping respiration, or agonal breathing is a distinct and abnormal pattern of breathing and brainstem reflex characterized by gasping labored breathing and is accompanied by strange vocalizations and myoclonus. Possible causes include cerebral ischemia, hypoxia, or anoxia. Agonal breathing is a severe medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and preludes death. The duration of agonal respiration can range from two breaths to several hours of labored breathing.

The respiratory rate is the rate at which breathing occurs; it is set and controlled by the respiratory center of the brain. A person's respiratory rate is usually measured in breaths per minute.

<span class="mw-page-title-main">John Cheyne (physician)</span> British physician, surgeon and author (1777–1836)

John Cheyne FRSE FKQCPI was a British physician, surgeon, Professor of Medicine in the Royal College of Surgery in Ireland (RCSI) and author of monographs on a number of medical topics. He was one of the people to identify Cheyne–Stokes respiration.

When we sleep, our breathing changes due to normal biological processes that affect both our respiratory and muscular systems.

<span class="mw-page-title-main">Respiratory center</span> Brain region controlling respiration

The respiratory center is located in the medulla oblongata and pons, in the brainstem. The respiratory center is made up of three major respiratory groups of neurons, two in the medulla and one in the pons. In the medulla they are the dorsal respiratory group, and the ventral respiratory group. In the pons, the pontine respiratory group includes two areas known as the pneumotaxic center and the apneustic center.

<span class="mw-page-title-main">Neurointensive care</span> Branch of medicine that deals with life-threatening diseases of the nervous system

Neurocritical care is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents, and treats secondary brain injury.

Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are overlapping syndromes of diffuse, symmetric, flaccid muscle weakness occurring in critically ill patients and involving all extremities and the diaphragm with relative sparing of the cranial nerves. CIP and CIM have similar symptoms and presentations and are often distinguished largely on the basis of specialized electrophysiologic testing or muscle and nerve biopsy. The causes of CIP and CIM are unknown, though they are thought to be a possible neurological manifestation of systemic inflammatory response syndrome. Corticosteroids and neuromuscular blocking agents, which are widely used in intensive care, may contribute to the development of CIP and CIM, as may elevations in blood sugar, which frequently occur in critically ill patients.

<span class="mw-page-title-main">Breathing</span> Process of moving air in and out of the lungs

Breathing is the rhythmical process of moving air into (inhalation) and out of (exhalation) the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen.

<span class="mw-page-title-main">Camille Biot</span> French physician

Camille Biot was a French physician who is remembered for describing Biot's respiration.

Central sleep apnea (CSA) or central sleep apnea syndrome (CSAS) is a sleep-related disorder in which the effort to breathe is diminished or absent, typically for 10 to 30 seconds either intermittently or in cycles, and is usually associated with a reduction in blood oxygen saturation. CSA is usually due to an instability in the body's feedback mechanisms that control respiration. Central sleep apnea can also be an indicator of Arnold–Chiari malformation.

Periodic breathing is clusters of breaths separated by intervals of apnea or near-apnea. As opposed to normal breathing which is usually regular, periodic breathing is defined as three or more episodes of central apnea lasting at least 4 seconds, separated by no more than 30 seconds of normal breathing.

<span class="mw-page-title-main">Respiratory inductance plethysmography</span>

Respiratory inductance plethysmography (RIP) is a method of evaluating pulmonary ventilation by measuring the movement of the chest and abdominal wall.

References

  1. 1 2 3 Stanifer, John. "A Peculiar Type of Dyspnea: Kussmaul, Cheyne-Stokes, and Biot Respirations" (PDF). Historia Medicinae. 3 (1).
  2. 1 2 (in French) Biot MC. Contribution a l'étude du phénomène respiratoire de Cheyne-Stokes. Lyon Med. 1876;23:517-528, 561-567.
  3. 1 2 3 4 Wijdicks EF (May 2007). "Biot's breathing". J. Neurol. Neurosurg. Psychiatry. 78 (5): 512–3. doi:10.1136/jnnp.2006.104919. PMC   2117832 . PMID   17435185.
  4. Alraiyes, Abdul Hamid; Thompson, Patrick ".; Thammasitboon, Supat (2011-05-01), "Biot's Respiration In A Chronic Opioid User: Improved With Adaptive-Servo Ventilation", C76. CONTROL OF VENTILATION AND RESPIRATORY MUSCLES, American Thoracic Society International Conference Abstracts, American Thoracic Society, pp. A5279, doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a5279 , retrieved 2022-06-13
  5. 1 2 3 Wijdicks EF (May 2007). "Biot's breathing". J. Neurol. Neurosurg. Psychiatry. 78: 512–3. doi:10.1136/jnnp.2006.104919. PMC   2117832 . PMID   17435185.
  6. Haubrich, William (2003). Medical Meanings: A Glossary of Word Origins (2nd ed.). American College of Physicians.
  7. Summ, Oliver; Hassanpour, Nahid; Mathys, Christian; Groß, Martin (2022-06-01). "Disordered breathing in severe cerebral illness – Towards a conceptual framework". Respiratory Physiology & Neurobiology. 300: 103869. doi: 10.1016/j.resp.2022.103869 . ISSN   1569-9048.