Tachypnea


Article Author:
Sharon Park


Article Editor:
Divya Khattar


Editors In Chief:
Chaddie Doerr


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
5/1/2019 4:17:51 PM

Introduction

Tachypnea is a condition that refers to rapid breathing. The normal breathing rate for an average adult is 12 to 20 breaths per minute. In children, the number of breaths per minute can be a higher resting rate than seen in adults. 

Etiology

Tachypnea does not necessarily have a pathological cause. For example, exercise can cause tachypnea. Some pathological causes of tachypnea are sepsis, diabetic ketoacidosis, respiratory issues such as pneumonia, carbon monoxide poisoning, pulmonary embolism, pleural effusion, asthma or COPD. Other medical issues such as allergic reactions, anxiety states, and foreign body aspiration can cause tachypnea as well.[1][2]

Epidemiology

Tachypnea in the newborn is a problem with the respiratory system that can be seen shortly after delivery. It can result from impaired clearance of fetal lung fluid which leads to respiratory distress. Transient tachypnea of the newborn has a higher prevalence in preterm infants. It occurs in approximately 1 in 100 preterm infants whereas, in term infants, it presents in about 4 to 6 per 1000 infants.[3][4]

Tachypnea in adults is breathing more than 20 breaths per minute. Twelve to twenty breaths per minute is a normal range. 

Pathophysiology

Tachypnea is a term used to define rapid and shallow breathing, which should not be confused with hyperventilation, which is when a patient's breathing is rapid but deep. Both are similar in that both result from a buildup of carbon dioxide in the lungs leading to an increase of carbon dioxide in the blood.[5]

This buildup of carbon dioxide in the blood makes the blood more acidic than usual, which alerts the brain and in response, the brain signals the respiratory drive to increase in pace in an attempt to correct the imbalance. In doing so, the blood pH can return to within the normal range in acidity. 

History and Physical

Patients may present with complaints of feeling short of breath. They also may say that they do not feel as if they can get in enough air. On physical exam, patients may have blue-tinged fingers or lips and/or use of accessory muscles or chest muscles to breathe. On the other hand, patients can present without any obvious symptoms. 

In newborns, tachypnea can be due to fluid retention in the lungs within the first 24 hours of birth. Infants can present with a blue color in the perioral area, grunting or signs of difficulty breathing, retraction of the chest while breathing, bobbing of the head and/or flared nostrils.[6][7]

Evaluation

The evaluation and cause of tachypnea are dependent on the patient's general disposition. Providers can evaluate based on oximetry, arterial blood gases, chest X-ray, chest CT, pulmonary function tests, glucose, electrolytes, hemoglobin, EKG, VQ scan, brain MRI and/or a toxicology screen. 

Arterial blood gases give an estimate of oxygen and carbon dioxide content which can assist in determining the pH as well as metabolic abnormalities. If the pH indicates acidosis, some potential causes are diabetic ketoacidosis, lactic acidosis or hepatic encephalopathy.[8] A blood sugar, if taken, can indicate or rule out diabetic ketoacidosis as well.[9][10]

A chest X-ray can depict any pulmonary causes of tachypnea, such as a pneumothorax, cystic fibrosis or pneumonia.[11] A chest CT, which shows greater detail, can be used to indicate any other lung pathologies or potential malignancies. Apart from imaging, pulmonary function tests can help determine causes from obstructive lung diseases such as COPD or asthma. VQ scans can be helpful if signs and symptoms point to a potential pulmonary embolus.[12] If tachypnea is due to cardiac abnormalities, an EKG will show evidence of a heart attack or abnormal heart rhythms.[13][14]

A complete blood count and complete metabolic panel can indicate any evidence for anemia or infections, which can potentially cause tachypnea. A toxicology screen can determine if there are any drugs, both prescription or non-prescribed, that may be causing tachypnea. 

Treatment / Management

Tachypnea should be treated depending on the underlying cause. 

If infants present due to transient tachypnea of the newborn, they can have treatment with extra oxygen and in some cases may require some time in the neonatal intensive care unit.[7]

If the tachypnea is due to asthma or COPD, patients can receive an inhaled medicine to dilate and expand the alveoli in obstructive lung disease. If due to pneumonia, the indication is for antibiotics in the treatment of bacterial pneumonia, but viral pneumonia can be treated supportively without antibiotics.[15]

Differential Diagnosis

While tachypnea refers to rapid, shallow breathing, other conditions can also be mistaken for tachypnea as they may present similarly. Hyperpnea refers to both rapid and deep breathing, and dyspnea indicates the sensation of shortness of breath. 

Prognosis

Tachypnea may be concerning for patients, but it is not always indicative of a critical illness. Though patients often require the advice of a medical professional, there are a variety of causes, and some may need immediate medical care. 

Complications

While tachypnea can result from physiological causes such as exercise, there are pathologic causes that may be of concern. The complications that arise from these pathologic causes are ones that clinicians should be aware of as they can lead to worsening physical exam and patient care outcomes.

Tachypnea can be a symptom of sepsis or acidosis, such as diabetic ketoacidosis or metabolic acidosis. Patients with lung problems such as pneumonia, pleural effusion, pulmonary embolism, COPD, asthma, or an allergic reaction also present with tachypnea.[16] Congestive heart failure can also be a cause of tachypnea and if not managed, can progress to worsening heart failure. 

Anxiety states and hyperventilation during panic attacks would lead to tachypnea and can lead to hypocapnia, or reduced carbon dioxide levels which in turn reduces respiratory drive. 

Deterrence and Patient Education

Patients should receive reassurance that tachypnea may not always indicate a serious medical illness. Patient education regarding the cause behind the patient's tachypnea is crucial. Patient understanding of their condition can help in proper management and follow-up of the condition. 

If there are any concerns, the safest course of action would be to seek medical advice right away to ensure diagnostic workup and treatment promptly. 

Enhancing Healthcare Team Outcomes

As expected, best possible outcomes for patient care involves an integrated and interprofessional team approach that includes an internist, nurse practitioner, pulmonologist, intensivist, and a laboratory specialist. If a patient is seen to be tachypneic, the role of clinical physical exam, imaging and laboratory values are significant. The patient should not be discharged until the tachypnea has resolved and consultations or referrals take place as deemed necessary. Healthcare professionals should discuss amongst themselves any significant complications or comorbidities. 

Collaboration and teamwork, as well as communication, are necessary for good outcome and prognosis. This collaboration should involve the entire interprofessional team including all physicians, specialty-trained nurses, and pharmacists or respiratory therapists, profession here appropriate, using an integrated and evidence-based approach to determining the plan and treatment leading to optimal patient care and outcomes. [Level V]

 


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Tachypnea - Questions

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An adult patient is noted to have a blood pressure of 147/72 mmHg and a respiratory rate of 32 breaths per minute at rest. The patient also complains of the sensation of shortness of breath and feels as though he "cannot get air in." On physical exam, he has blue-tinged fingers and lips. What is the best description of this breathing pattern?



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A 12-hour old infant is dyspneic with an oxygen saturation of 84%. Physical examination shows subcostal retractions and perioral cyanosis. Which finding on chest x-ray is most indicative of a diagnosis that does not require surgery?



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A female infant is born via normal spontaneous vaginal delivery at 40 weeks gestation to a mother who had good prenatal care. The infant is seen grunting to breathe and shows bilateral subcostal and intercostal retractions. The newborn is seen closely for a few hours following delivery, and the respiratory status improves over that time period. Which of the following is the most likely explanation for this course?



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A six-year-old boy is brought to the emergency department after a possible medication overdose. He was playing near his parents' medicine cabinet and ingested a handful of tablets. He is complaining of severe ringing in his ears. His temperature is measured to be 39.6 C, and respiratory rate is 35 breaths per minute. Which of the following is the most likely ingested agent?



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A 54-year-old patient with a past medical history of nicotine abuse, smoking 1pack per day for the last 32 years, presents to the clinic complaining of shortness of breath with a cough. He states the cough is productive of yellowish sputum. Physical examination notable for tachypnea and a prolonged expiration with wheezing bilaterally. He appears to be in distress with use of accessory muscles. Which of the following is the most common trigger for his condition?



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A group of individuals present to the emergency department with headache, nausea, vomiting, and confusion from an indoors barbecue. Physical examination of one patient shows a heart rate of 112 bpm, respiratory rate of 22 breaths per minute, and a pink hue of the skin. Which of the following is the most appropriate investigation to confirm the underlying diagnosis?



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A 42-year-old male with no known medical history is admitted to the hospital following a motor vehicle accident. He is treated for multiple lacerations on his face and chest along with multiple nondisplaced rib fractures. Three days after admission, the patient develops confusion, agitation, diaphoresis, and tremors. Physical examination shows a blood pressure of 152/82 mmHg, heart rate of 112 beats per minute and respiratory rate of 23 breaths per minute. Which of the following is the most likely diagnosis?



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A 26-year-old female with no significant past medical history presents to the emergency department with a cough after "inhaling food." The patient states that she was eating dinner and watching TV when she laughed with a mouth full of food and started coughing. She reported the cough subsided initially but now seems to have started again. On examination, she has mild hypoxia and tachypnea but remains afebrile and hemodynamically stable. Her chest x-ray shows a right lower lobe infiltrate. Which of the following is the most likely diagnosis?



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Tachypnea - References

References

Takayama A,Takeshima T,Nakashima Y,Yoshidomi T,Nagamine T,Kotani K, A Comparison of Methods to Count Breathing Frequency. Respiratory care. 2019 May     [PubMed]
Asmundsson AS,Arms J,Kaila R,Roback MG,Theiler C,Davey CS,Louie JP, Hospital Course of Croup After Emergency Department Management. Hospital pediatrics. 2019 Apr 15     [PubMed]
Chowdhury N,Giles BL,Dell SD, Full-Term Neonatal Respiratory Distress and Chronic Lung Disease. Pediatric annals. 2019 Apr 1     [PubMed]
S D,O G, A Novel Mutation in a Newborn Baby Leading to Glycogen Storage Disease Type Ia. Balkan journal of medical genetics : BJMG. 2018 Dec     [PubMed]
Prado PRD,Bettencourt ARC,Lopes JL, Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern. Revista brasileira de enfermagem. 2019 Jan-Feb     [PubMed]
Oktem A,Yigit S,Oğuz B,Celik T,Haliloğlu M,Yurdakok M, Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2019 Apr 22     [PubMed]
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Nguyen PTK,Tran HT,Fitzgerald DA,Tran TS,Graham SM,Marais BJ, Characterisation of children hospitalised with pneumonia in central Vietnam: a prospective study. The European respiratory journal. 2019 Jul     [PubMed]
Kavurmacı Ö,Akçam Tİ,Kavurmacı SA,Turhan K,Çağırıcı U, Pneumothorax: A Rare Entity During Pregnancy. Turkish thoracic journal. 2019 Apr 9     [PubMed]
Esquer Garrigos Z,George MP,Khalil S,Vijayvargiya P,Abu Saleh OM,Friedman PA,Steckelberg JM,DeSimone DC,Wilson WR,Baddour LM,Sohail MR, Predictors of Bloodstream Infection in Patients Presenting With Cardiovascular Implantable Electronic Device Pocket Infection. Open forum infectious diseases. 2019 Apr     [PubMed]
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