Diseases

Respiratory Depression – Causes, Symptoms & Treatment

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The following describes exactly what respiratory depression or hypoventilation is, how it can be caused, and what symptoms might indicate it. Furthermore, information on the medical diagnosis, the course as well as the treatment and prevention of respiratory depression is given.

What is respiratory depression?

The normal number of breaths for the average adult is around 16 to 20 breaths per minute.

One speaks of respiratory depression when the frequency of breathing is reduced, i.e. when breathing is slowed down with fewer than ten breaths per minute. However, these do not necessarily contain less volume than is the case with breathing at a normal rate, which is why respiratory depression does not usually lead to respiratory distress in the person concerned.

The problem, however, is that the body’s gas exchange cannot take place optimally as a result, which can lead to difficulties in maintaining the human organ functions.

causes

Respiratory depression occurs when the respiratory center does not respond optimally to the respiratory drive that regulates the levels of carbon dioxide (CO2) and oxygen (O2) in the blood.

If, for example, the CO2 content of a person’s blood is too high, the number of breaths per minute can be increased when the respiratory drive is increased in order to reduce the CO2 in the blood by exhaling it. If a person suffers from respiratory depression, this gas exchange can no longer take place properly because breathing is too superficial or too slow. This leads to an increased CO2 partial pressure in the blood and there is a risk of suffocation for the person concerned.

In terms of causes, a distinction must be made between peripheral and central respiratory depression.

In the case of peripheral respiratory depression, the cause is not in the central control in the central nervous system , which is still intact, but in the periphery. It can be caused by an overdose of muscle relaxants, various neurological disorders, or airway obstruction.

In central respiratory depression, on the other hand, the respiratory center in the brain is no longer fully functional. This occurs, for example, as a result of certain medications, a traumatic brain injury, sleep apnea syndrome, increased intracranial pressure, poisoning of the body with alcohol or morphine, for example, or as a result of a cerebral infarction .

Symptoms, Ailments & Signs

Respiratory depression is primarily characterized by slow breathing. This leads to shortness of breath and shortness of breath. Finally, there are acute symptoms of suffocation and, as a result, a panic attack , which manifests itself in sweating and an increased heart rate. Respiratory depression is also manifested by sleep problems , fatigue and anxiety.

Mental deficits as well as confusion and lack of concentration can also occur. Many sufferers suffer from muscle twitching or cyanosis , a blue discoloration of the skin, which is particularly noticeable on the fingers and the mucous membranes in the mouth. Respiratory depression can also cause psychological problems.

Depression and anxiety disorders are sometimes associated with a chronic lack of oxygen supply to the brain. As the disease progresses, the symptoms mentioned increase in intensity and usually lead to further complaints. Externally, respiratory depression can be recognized primarily by the aforementioned cyanosis and the characteristic muscle twitching.

Pallor and changes in pupil size can also occur. Finally, respiratory depression manifests itself in respiratory arrest, which if left untreated leads to death. Respiratory depression as a result of morphine poisoning can manifest itself, for example, in nausea and vomiting, exhaustion and a number of other symptoms.

Diagnosis & History

Symptoms that may be caused by respiratory depression include shortness of breath, trouble sleeping, weakness , anxiety , confusion , delirium, fatigue , seizures, muscle twitching , or cyanosis in the sufferer. However, these possible symptoms by no means allow a clear diagnosis of respiratory depression, which can only be diagnosed by a blood gas analysis carried out by a doctor.

The exact degree of respiratory depression can also be determined here, to what extent it is hazardous to the patient’s health and what measures must be taken. The course differs depending on the degree of respiratory depression. In the case of a pronounced respiratory depression, after the steady increase in the CO2 content in the blood and serious breathing problems, respiratory arrest can finally occur if sufficient measures are not taken to counteract these reactions.

complications

Respiratory depression can cause a number of complications. Initially, the reduced respiratory rate leads to fatigue, muscle twitching or confusion ; Symptoms that can progress to seizures, delirium, and anxiety disorders . If left untreated, respiratory depression also leads to shortness of breath, which worsens over time and can eventually lead to respiratory arrest.

If there is no acute treatment by then at the latest, the circulatory system collapses and, as a result, the affected person ends up in a coma and dies. Respiratory depression as a result of morphine poisoning is accompanied by other symptoms such as nausea and vomiting as well as exhaustion. Complications in treating respiratory depression may arise when mechanical ventilation becomes necessary; then there is a risk of sore throat, cough, chronic infectious diseases or pneumonia.

Rarely, hemoptysis, bloody sputum as a result of a severe infection, can occur. Certain medications can also increase respiratory depression and subsequently cause sleep apnea, increased intracranial pressure or even a cerebral infarction. Early treatment of the disease is the most effective way to prevent a severe course and possible complications of respiratory depression.

When should you go to the doctor?

Ideally, respiratory depression is prevented through regular check-ups and comprehensive medical treatment. Patients at risk (patients with nerve injuries, trauma or neurological diseases) should clarify the possible consequences and risks of the underlying disease. The same applies to people who regularly take opioids, barbiturates or sedatives. By clarifying the dangers, it is possible to react quickly and comprehensively in the event of respiratory depression.

If acute respiratory depression occurs, the emergency doctor must be alerted immediately . Whether it is hyperventilation can be determined by various warning signs. Most often, the symptom is associated with decreased breathing movement, blue lips or fingers, and fatigue. In the further course, circulatory weakness and finally respiratory arrest occur.

If one or more of these signs are observed, the affected person must be treated immediately. Until the arrival of the rescue service, first aid measures and possibly also resuscitation measures must be carried out. In addition, if possible, the cause of the respiratory depression should be determined in order to enable prompt treatment.

Treatment & Therapy

When treating respiratory depression, the primary focus is on the trigger, since this is the only way to completely counteract respiratory depression.

If a patient is diagnosed with respiratory depression due to morphine poisoning, the symptoms of respiratory depression are counteracted in addition to treatment of the morphine poisoning with the morphine antagonist naloxone and gastric lavage, for example by intubation and mechanical ventilation or heart massage of the person concerned.

The type of treatment also depends on the degree of respiratory depression. If the patient suffers from serious breathing problems and the heart and brain are no longer sufficiently supplied with oxygen, it may have to be ventilated before the actual causes that lead to these symptoms can be tackled.

Outlook & Forecast

Respiratory depression can become a life-threatening condition without medical treatment. The permanent undersupply of the organism with oxygen triggers shortness of breath, sleep disorders and permanent high blood pressure . Without medical treatment, the risk of a sudden malfunction or system failure increases. There is a threat of an acute condition that can lead to lifelong impairments or secondary diseases.

In severe cases, multiple organ failure sets in, resulting in death. With the permanent overloading of the heart muscle with high blood pressure, the risk of heart failure increases . The patient faces significant health problems for the rest of his life or a fatal course of the disease.

With medical care for the patient, the chances of recovery increase immensely. If you have mild respiratory depression, you have a good chance of being free of symptoms. Learning breathing techniques or managing healthy breathing in different situations can provide lasting relief. The more severe the condition, the greater the likelihood that ongoing medical care will be necessary to avoid experiencing deterioration in health.

In the case of pronounced respiratory depression, the chances of recovery decrease significantly. If there is no possibility that the CO² content in the blood increases permanently, significant irregularities occur. These can lead to an unexpected respiratory arrest and thus to the death of the patient.

prevention

The same applies to preventing respiratory depression: Since respiratory depression is not a disease in its own right, but is triggered by other malfunctions in the body, the only possible preventive measure is to avoid it if possible.

aftercare

Mild respiratory depression offers a good chance of complete recovery. If this is successful, you can do without aftercare. A recurrence is not expected for the time being. However, that does not mean that immunity will arise. The patient may recur from the same or different causes that trigger respiratory depression.

The situation is different if the causes of respiratory depression are not cured causally. Then there are the typical symptoms. Respiratory depression leading to death can occur at any time. It is important to prevent complications and to realize a symptom-free everyday life. The doctor treating you usually orders imaging procedures as part of the aftercare.

CT and MRI in particular provide clarity about muscle and nerve damage. Depending on the intensity of the underlying disease, the doctor determines outpatient or inpatient monitoring. Drug therapy is often sufficient. For example, naloxone acts as an antidote when respiratory depression is triggered by opioids. In other cases, breathing training helps.

The patient learns how to ensure a sufficient number of deep breaths. In acute, life-threatening situations, artificial respiration is unavoidable. This prevents a lack of oxygen in the brain. People who notice reduced breathing must call an ambulance.

You can do that yourself

Respiratory depression is typically recognizable by a reduced respiratory rate of less than ten breaths per minute. There is then a general undersupply of the body with oxygen. This can result in symptoms such as confusion, seizures, muscle twitching and the externally visible blue discoloration of the skin (cyanosis). Respiratory depression can have many different causes, so that adjustments in everyday life and possible self-help measures must be geared to them.

If a person suffers acute respiratory depression, rapid action is required, so calling an ambulance is recommended because life-threatening respiratory arrest can also occur. In cases where breathing is impaired as a result of persistent drug abuse or poisoning, a first self-help measure can be, for example, voluntary vomiting .

The most common reason for breathing pauses is nocturnal sleep apnea attacks, which are caused by obstruction of the trachea through the uvula in the soft palate. The most important self-help is then to prevent the obstruction of the trachea by taking appropriate measures such as wearing a CPAC mask that works with a slight positive pressure.

Respiratory depression can either be controlled centrally via the respiratory center or can be traced back to local organic problems. Adaptation to everyday life and self-help is often not possible in such cases. Artificial respiration – temporarily or permanently – may even be necessary as an emergency measure.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.