Kussmaul's respiration

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    OK - I work in the OR and don't see this much - OK I don't see it at all.

    Last night, my wife and I went to be with her dying uncle (taken off respirator, s/p head injury). This was both an unsettling and profound experience. I've never had the honor (yes, I consider it an honor) of being in the presence of a family member as they were dying - just being there with the family.

    This wonderful gentleman had what I think was Kussmaul's respirations towards the end. I only remember it from school and studies. He had shallow breathing, progressivly got deeper, then progressively got more shallow again, skipping a breath or two, then starting the process all over again. This went on for a while (about 2 to 3 hours), then turned into "gasps" for about the last hour or so. The nurse provided a bolus of MSO4 to help calm the breathing, but didn't help much.

    Does anyone have any knowledge about Kussmaul's? Is it not an acid/base imbalance? I had trouble finding a good link on the net. Is it always an end-of-life breathing pattern? Was it typical to change to gasping, rather than just decreasing in depth-of-breath until it stops?

    Thanks, Dave

    P.S. - I do not believe that he was in pain. He passed peacefully, and the family was comforted by each other, the pastor, and knowing that he was no longer hungering for air and went to be with the Lord and his family who preceeded him in death... Bless all you nurses out there who are with families for the final moments of their loved ones - you are truly special.
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  3. 11 Comments so far...

  4. 0
    I've seen both gasping and just a gradual cessation of breathing. It's different for everyone, but the gasping is very common. When someone is Kussmauling the morphine given is for the family's benefit, not the pt's......I believe the pt is beyond feeling distress at that point.
  5. 0
    Sounds like Cheyne-Stokes breathing not Kussmauls. Any good pathophysiology book or Med-Surg nursing book can explain them both.
    Take care.
  6. 0
    Whoops.......Kussmauling is done by DKA's, sorry! You're right, MacD!!!
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    I agree with you that it is an honor to be in the presence of someone in their dying moments and that it is indeed a profound and unsettling experience. I have sadly, had the honor, in the field of nursing that I have chosen, to experience this several times. I have never been able to express in words what the experience is like; your words describe the experience perfectly. It is truly a blessing for someone pass peacefully, if death is a certain outcome. I am sorry for your loss.
    In regards to the breathing. I think, and I could be mistaken that Kussmaul respirations are deep and rapid, with no real repeating pattern...regular or irregular, but with no distinct pattern. I believe that it occurs when someone is in ketoacidosis, a type of metabolic acidosis. The breathing that you describe I believe is called Cheyne-Stokes. Where there is a pattern of shallow breaths, that speed up, stop and then start again. It is also an imminent sign of death, from brain injury. I could be mistaken; without getting out the med-surg books...this is just from memory.
  8. 0
    Quote from CIRQL8
    This wonderful gentleman had what I think was Kussmaul's respirations towards the end. I only remember it from school and studies. He had shallow breathing, progressivly got deeper, then progressively got more shallow again, skipping a breath or two, then starting the process all over again. This went on for a while (about 2 to 3 hours), then turned into "gasps" for about the last hour or so. The nurse provided a bolus of MSO4 to help calm the breathing, but didn't help much.
    The first few hours were Cheyne-stokes, and the last ones were agonal.


    Pathophysiology and treatment of Cheyne-Stokes respiration -- Naughton 53 (6): 514 -- Thorax
  9. 0
    Ok, yes, Cheyne-Stokes - correct. Thank you. See what happens when you don't practice it?? This is one reason why I listen to the docs grill the residents and read thsese threads. Keeps my memory a little fresher.

    Thank you all for your kind words.
  10. 0
    cheyne-stokes is a cyclic fluctuation in respiratory rate and depth.
    from periods of brief apnea, the breaths become progressively faster and deeper, then slower and more shallow until apnea sets in; then the cycle begins again.

    whereas kussmaul's is indicative of diabetic acidosis or diabetic coma. cheyne stoking can be caused by heart failure, neuro insults and meds.
    and cheyne stokes is very common when one is actively dying.

    leslie
  11. 0
    That is not kussmauls breath that in cheyne stokes which is typical for the head injured patient with rising ICP and herniation syndrome. Sorry about your loss.

    Swtooth
  12. 0
    My husband went into Kussmauls when he went into metabolic acidocisis from acute renal failure, secondary to Lymphoma. Nightmarish situation, he ended up in ICU on dopamine and receiving dialysis. He died about a month later. Bad memory...


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