Neuro breath

Updated:   Published

I was looking for anything on Neuro breath when I came across this thread from a few years ago. Most of what I read seemed to deal with just adequate oral care, but I believe there's something else going on with patients who have brain damage. This is what one of the posts said:

I asked a Neuro Sergeon about this bad breath. This terrible breath seems to even smell similar. I said that it was terrrible even after repeated episodes of oral care. We've tried everything. The best for decreasing the smell and also aids in the repair of oral trauma is a 1:1:1 ratio mixture of NS, Peroxide and Cepecol. Anyway this doctor explained the breath problem. I don't know if he was giving me a load of BS but, his story sounds plausable. He said that it was an enzyme given off by trauma or injury to the brain. This enzyme's effect was like the "fruity" breath given off by diabetics. Only this enzyme produces rancid breath. I however, haven't found data to back up his claims.

In my experience the odor coming off of neuro patients (those with brain damage extensive enough that they are comatose for several days, typically intubated, probably have SAH, IPH, shearing injuries, GCS typically 4-8, posturing, probably enduring a swelling phase so they're on hypertonic saline or mannitol, maybe have an EVD) 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 hear that hunting dogs are trained to find their game/target based on a smell/odor given off by the injured target. Maybe the brain gives off some enzyme when it's injured. The other thing I've noticed, but haven't followed up on it, is that those with the smell tend to have poor prognosis. I would love to be able to follow up on my patients that get the smell, but don't end up dying (not a very large percentage) and see how their lifestyle progresses after the ICU. I know it's a very subjective assessment finding, but I feel like it could almost be used diagnostically. We could talk for hours about proper oral hygiene, but over the last seven years I haven't found that oral care, regardless of how vigorous and complete it is and regardless of the cocktail of cleansing agents and good smelling fluids we use, makes any difference at all. At best it only temporarily masks the smell. Thoughts?

spacemonkey15

117 Posts

Specializes in Critical care. Has 13 years experience.
ncloward said:
I was looking for anything on Neuro breath when I came across this thread from a few years ago. Most of what I read seemed to deal with just adequate oral care, but I believe there's something else going on with patients who have brain damage. This is what one of the posts said:

I asked a Neuro Sergeon about this bad breath. This terrible breath seems to even smell similar. I said that it was terrrible even after repeated episodes of oral care. We've tried everything. The best for decreasing the smell and also aids in the repair of oral trauma is a 1:1:1 ratio mixture of NS, Peroxide and Cepecol. Anyway this doctor explained the breath problem. I don't know if he was giving me a load of BS but, his story sounds plausable. He said that it was an enzyme given off by trauma or injury to the brain. This enzyme's effect was like the "fruity" breath given off by diabetics. Only this enzyme produces rancid breath. I however, haven't found data to back up his claims.

In my experience the odor coming off of neuro patients (those with brain damage extensive enough that they are comatose for several days, typically intubated, probably have SAH, IPH, shearing injuries, GCS typically 4-8, posturing, probably enduring a swelling phase so they're on hypertonic saline or mannitol, maybe have an EVD) 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 hear that hunting dogs are trained to find their game/target based on a smell/odor given off by the injured target. Maybe the brain gives off some enzyme when it's injured. The other thing I've noticed, but haven't followed up on it, is that those with the smell tend to have poor prognosis. I would love to be able to follow up on my patients that get the smell, but don't end up dying (not a very large percentage) and see how their lifestyle progresses after the ICU. I know it's a very subjective assessment finding, but I feel like it could almost be used diagnostically. We could talk for hours about proper oral hygiene, but over the last seven years I haven't found that oral care, regardless of how vigorous and complete it is and regardless of the cocktail of cleansing agents and good smelling fluids we use, makes any difference at all. At best it only temporarily masks the smell. Thoughts?

This was discussed in a thread not so long ago: https://allnurses.com/neuro-intensive-care/bad-breath-in-965628.html

There's talk about the enzyme theory in that as well, which is something that as new to me, as I'd always made the assumption and had been told by colleages that it was more likely to be related to people having base of skull fractures and CSF/stale blood/goo/poor oral care being the cause.