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Cheyne-Stokes Breathing Pattern

Cheyne-Stokes breathing pattern received its name in honor of the Scottish military doctor John Cheyne and the Irish doctor, Professor William Stokes. They discovered it in the middle of the 19th century and described on patients with severe heart failure and stroke. The infrequent shallow breaths in and out gradually become more frequent and deeper. After the breathing intensity reaches its maximum, respiratory movements begin to weaken again, sometimes up to their complete cessation – an episode of central apnea, and then the abnormal respiratory cycle repeats.

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The physiology of this breathing pattern is described as follows. With a decrease in pulmonary ventilation and subsequent apnea, an increase in the concentration of carbon dioxide in the blood occurs. The respiratory center is excited, resulting in a resumption of breathing and a period of compensatory hyperventilation leading to the other extreme: a significant decrease in the level of carbon dioxide in the blood. This again leads to respiratory depression and apnea, thus, making this pattern circular.

For a long time, it was believed that Cheyne-Stokes breathing in heart failure not only reflects the patient’s severe condition but is also an independent factor that increases the risk of death. Therefore, nursing interventions need to be utilized to monitor and treat such patients. The most effective and technologically advanced method for treating Cheyne-Stokes breathing has become adaptive servo-ventilation (Oldenburg et al., 2015). This is a variant of mask-assisted ventilation, in which the device adapts as much as possible to the patient’s breathing characteristics. It helps to fully compensate for the shortness of breath in hypopnea and apnea but turns off while the person is breathing normally. However, when conducting large studies, an unexpected and paradoxical result was obtained – adaptive servo-ventilation in patients with chronic heart failure. It is a result of a significant decrease in the function of the left ventricle of the heart that causes an increase in mortality (Oldenburg et al., 2015). As a consequence, controversy about the role of Cheyne-Stokes respiration and approaches to its treatment flared up with a new layer.

Reference

Oldenburg, O., Spießhöfer, J., Fox, H., Bitter, T., & Horstkotte, D. (2015). Cheyne-Stokes respiration in heart failure: friend or foe? Hemodynamic effects of hyperventilation in heart failure patients and healthy volunteers. Clinical Research in Cardiology, 104(4), 328-333. Web.

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