Neuro Breath: Neuro ICU Mystery Explained

Healthcare providers have described neuro breath as a foul odor unique to Neuro ICU patients who have experienced brain damage.

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Neuro Breath: Neuro ICU Mystery Explained

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A healthcare phenomenon that many have never heard of or discussed is plaguing Neuro Intensive Care Units and units treating patients with traumatic brain injuries or TBIs. This phenomenon is neuro breath, and the condition's causes go deeper than many might think.

What Is Neuro Breath? 

Healthcare providers have described neuro breath as a foul breath odor unique to patients in the Neuro ICU who have experienced brain damage via a TBI or some other type of brain injury, despite exceptional and adequate oral care for the patient. 

What Does Neuro Breath Smell Like?

Nurses working in any Neuro ICU seem to have very similar descriptions of the odor that these patients produce:

  • "In my experience the odor coming off of neuro patients smells the same across the board. It's the same smell regardless of any demographic and it tends to come on around day two or three and gets worse after a day or two.” 
  • "I asked the neurosurgeon why the patient's with traumatic brain injury tend to have a specific smell on their breath regardless of bathing, oral care, etc. He was able to explain that the smell is due to glutamate that is released by the death of brain cells. There is not anything that can be done to remove the smell.” 

Neuro Breath Causes

There are two primary neurotransmitters in the brain that providers talk about in relation to TBIs and neuro breath: Glutamate and GABA.

Glutamate is an amino acid and is the primary excitatory neurotransmitter used for relaying messages from nerves to muscles. Nearly all brain cells use it to exchange messages. GABA is the primary inhibitory neurotransmitter and works by inhibiting chemical messages from transmitting from brain cell to brain cell. Balancing these two neurotransmitters is essential for maintaining normal neurological function.

When a TBI occurs, excitation (glutamate) and inhibition (GABA) are imbalanced, leading to a glutamate storm. The excess glutamate in the brain can lead to brain cell damage and death as the nerve cells become overexcited. This death of brain cells leads to the smell that healthcare professionals often detect in patients suffering from TBIs—“neuro breath.” It is similar to the fruity breath often associated with diabetes, except the smell is far more potent. 

Caring for Patients with Traumatic Brain Injury 

There are different types of severities of traumatic brain injuries. The two broad types of TBIs are penetrating and non-penetrating injuries.

In a penetrating injury, an object pierces the skull and enters the brain tissue. In a non-penetrating injury, an external force impacts the head so hard that it causes the brain to move within the skull. Some of the leading causes of TBIs include the following:

  • Falls
  • Blunt trauma accidents 
  • Explosions/blasts
  • Assaults and violent assaults
  • Vehicular related injuries 

Patients with a suspected TBI will require similar tests, including but not limited to CT scans and MRIs. Healthcare professionals frequently use the Glasgow Coma Scale to assess a patient's level of consciousness after a TBI. 

Regardless of the type or severity of the injury, all patients diagnosed with a TBI will require some degree of care. The most significant factor in determining that level of care is the severity of the injury sustained. Although patients sustain much damage at the moment of impact, those with severe TBIs can develop secondary brain injuries days or weeks after the initial trauma.

Related: Curving the Risk of Dementia: Ways to Keep Your Brain Healthy

Patients with a mild TBI may only require simple measures, such as rest and avoidance of any activity that puts them at risk for a further head injury. They should pay close attention to any new or developing symptoms and may take the following medications:

  • Over-the-counter pain relievers 
  • Anticonvulsants (for seizure activity)
  • Anticoagulants (to prevent blood clots) 
  • Diuretics (reduce fluid buildup and treat and prevent brain pressure)
  • Antidepressants 
  • Anti-anxiety medications  

Patients with severe TBIs require the highest care level, typically treated in a neuro intensive care unit. Immediate care, if necessary, focuses on preventing death while stabilizing all body systems. These patients will require close monitoring of skull pressure, blood flow and oxygen supply to the brain, and more. 

Healthcare professionals must take great care to avoid further complications such as infection, particularly pneumonia and prevention of blood clots, while these patients are unable to ambulate. Patients with severe TBIs often require neurosurgery and close monitoring by neurosurgery and neurology providers to monitor for further brain dysfunction. 

Regardless of the severity and degree of the TBI sustained, patients deserve to be cared for as a whole, remembering that they will likely need assistance with basic ADLs until they progress further in their recovery. These patients will often require intensive physical, speech, and occupational therapies until they can gain confidence and function sustainably. The field of neuroscience is still a bit of a mystery, but when research uncovers pieces such as this, it helps healthcare professionals understand more about the brain and its wonders. 

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Lauren Thayer

About Lauren Thayer, RN

(Editorial Team / Admin)

Lauren is a Registered Nurse with 8+ years of nursing experience.

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Specializes in Population health & Epidemiology.

Interesting! Aside from a few shifts during my float pool days, I don't have much ICU experience, but I do remember one critical TBI patient that had persistently lousy breath, no matter what we did regarding oral care. Thanks for the explanation!

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Specializes in Adult and Pediatric I C U.

  That is really interesting. I have had a lot of TBI neuro patients, and never knew that is why, despite providing good oral care, their breath was awful.

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Hi! Do you have any sources I could cite regarding the info above? Ty

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