Breathing Pattern in Severely Sick People
Again, we can use two approaches: our observational skills and medical evidence.
Have you seen on TV or in real life how sick people die? Do you remember how they gasp for air? Do these gasps, just before death, become more frantic?
The analysis of medical literature suggests that critically ill patients die in conditions of heavy and deep breathing. This general picture can be predicted from the Homepage that has several graphs showing over-breathing in patients with heart disease, asthma and diabetes.
Critical care professionals use the most complicated and advanced devices and tools to measure various physiological parameters. Analysis of the arterial blood for different components includes investigation of blood gases (blood values for bicarbonates, CO2, oxygen, etc.) of the critically ill and severely sick patients.
Respiratory patterns and blood gases and provided accurate information for survival chances in acute cerebrovascular accidents. When these parameters were normal, patients survived. Out of 11 hyperventilating patients with less than 35 mm Hg aCO2, only one survived (Rout et al, 1971).
The same conclusion (regarding aCO2 and survival prognosis) was made for head injuries (Huang et al, 1963; Vapalanti & Trouph, 1971).
Clinical research on cancer, which is summarized on the web page devoted to breathing frequency in terminal cancer patients also found the same conclusions: Breathing rate of cancer patients is an independent factor that predicts their survival. The faster they breathe, the sooner they die.
All 29 patients with severe damage to the liver (in most cases due to metastasized cancer and cirrhosis of the liver) had low CO2 values, while for 26 patients "it was also clinically evident that their respiratory exchange was increased markedly" (see p.762, Wanamee et. al., 1956). Hence, severe over-breathing was visually observed by the authors of this study, "Respiratory alkalosis in hepatic coma". They also discovered that heavy over-breathing led to blood plasma electrolyte abnormalities. These abnormalities included increased chloride ions in the blood and reduced sodium ions. Abnormally high pyruvic and lactic acid values were other usual effects.
Summarizing results of these and other works and their connection with brain and CNS dysfunction, Dr. Plum suggested, "The combination of hyperpnoea [over-breathing] with an elevated blood pH, and a subnormal or moderately low oxygen tension occurs in many serious illnesses that entirely spare the brain. These include the alveolar-capillary block of diffuse pulmonary carcinomatosis; heart failure; advanced cirrhosis, with or without hepatic coma; acute pulmonary infarction; and many others, including the cryptic pulmonary congestion that accompanies most serious disease in the obtunded and elderly" (Plum, 1972). Interestingly, the above-mentioned effects (low CO2 concentration, elevated blood pH, and cell hypoxia) quoted by Dr. F. Plum are caused by heavy breathing.
Hence, one can conclude that over-breathing is a normal feature in the critically ill.
How and why do people die due to heart disease, diabetes, asthma, cancer, AIDS, and other chronic diseases? What is the physiological mechanism of death? Patient’s life is threatened by various complications and infections, such as in the case of bacteremia or bacteremic shock. Analysing a group of fifty patients initially diagnosed with arteriosclerotic diabetes, arthritis, heart disease, cerebrovascular insufficiency, fatty liver, several forms of cancer, and alcoholism, various complications due to pathological microorganisms in the blood caused 92% of deaths (see below, Winslow et. al., 1973). The lungs and the urinary tract were the foci of infections due to pathogenic microorganisms. All these 50 patients, according to a large table accompanying this article ("Hemodynamic studies and results of therapy in 50 patients with bacteremic shock"), had very disturbed parameters of their blood gases that were corresponding to severe over-breathing.
In another study, Dr. Simmons with colleagues wrote an article with the title "Hyperventilation and respiratory alkalosis as signs of gram-negative bacteremia" (bacteremia means the presence of bacteria and other pathogens in the blood). They wrote:
"Visible hyperventilation was clearly observed clinically in patients with Gram-negative bacteremia. 11 patients with Gram-negative bacterial infections and either proved or probable bacteremias were studied to see if hyperventilation could be a common response to such bacteremia. In each case there was laboratory evidence of hyperventilation present, and in 8 cases the hyperventilation was even visible to the observer..." (abstract, Simmons et al, 1960).
A group of American MDs found that the degree of hyperventilation has a strong correlation with mortality (Mazarra et. al, 1974). Heavier breathing indicated reduced chances of survival. This is what they wrote in their abstract:
"Respiratory alkalosis [high blood pH is the normal result of over-breathing] was the most common acid-base disturbance observed in a computer analysis of 8,607 consecutive arterial blood gas studies collected over an 18 month period in a large intensive care unit."
All these findings suggest that extreme hypocapnia (low CO2) in the critically ill patients is indicative of the severity of the underlying disease and has serious prognostic implications" (Mazarra et. al., 1974).
This article found that the most common immediate diseases that could cause death were hepatic coma, bronchopneumonia, cerebrovascular disease, and arteriosclerotic heart disease.
A review of these medical professional studies indicates that critically ill patients usually have very low CO2 level due to severe hyperventilation. Laboured breathing or even panting at rest (dyspnea) of such patients usually corresponds to minute ventilation of 20-25 l/min or more, while body oxygen content is less than 10 s. Their typical breathing pattern is shown below.
Fig. Ineffective breathing pattern of very sick people: deep and fast breathing, but body oxygenation is low (less than 10 s for the oxygenation index or CP)
References (Breathing pattern in severely sick people)
Wanamee P, Poppel J, Glicksman A, Randall H, and Roberts KE, Respiratory alkalosis in hepatic coma, Archive of Internal Medicine 1956, 97: p. 762-7.
Plum FC, Hyperpnea, hyperventilation and brain dysfunction, Annals of Internal Medicine 1972, 76: p. 328.
Mazarra J, Ayres S, and Grace W, Extreme hypocapnia in the critically ill patient, American Journal of Medicine, Apr 1974, 56: p. 450-6.
Huang C, Cook A, and Lyons H, Severe cranio cerebral trauma and respiratory abnormalities, Archives of Neurology 1963, 9: p. 545-4.
Rout M, Lane D, and Wolliner L, Prognosis in acute cerebrovascular accidents in relation to respiratory pattern and blood gas tension, British Medicine Journal, 1971, 3: p. 7-9.
Simmons D, Nicoloff J, and Guze L, Hyperventilation and respiratory alkalosis as signs of gram-negative bacteremia, Journal of American Medical Association 1960, 174: p. 2196-9.
Vapalanti M and Troup H, Prognosis for patients with severe brain injuries, British Medical Journal 1971, 3: p. 404-7.
Winslow E, Loeb H, Rahimtoola S, Kamath S, and Gunnar R, Hemodynamic studies and results of therapy in 50 patients with bacteremic shock, American Journal of Medicine 1973, 54: p. 421-6.