Hyperpnea vs. Hyperventilation vs. Kussmaul's

[Jedi of Zen]

Could anyone explain the difference between these 3 terms?

I'm not necessarily looking for particular websites or textbook definitions, because I already know what they are. Although if you happen to know of any sites that are particularly good (ie, besides wikpedia, webmd, and all the other walmart-quality of sources out there), feel free to post them.

What I would really be interested in, though, is hearing a layman's definition from a nurse who already works with pulmonary-problem patients. ie, someone who has actual experience, understands these term, and can do more than just quote a textbook. (Not to belabor the point, but I'm just having a hard time establishing some consistency among all the texts that I'm researching.)

I know that there is already a student forum for questions. I don't normally post questions outside of that forum, but I would really, really like to hear from a pulmonary-experienced RN on this.

Thanks so much.

[PageRespiratory!]

I know I went to school a long time ago...and I am not a respiratory therapist (but I stayed in a holiday inn last night)...

I believe that respiration is mechanism by which we obtain oxygen from the air and eliminate CO2 from our blood. Ventilation is part of that process, the part involving the movement of air into and out of the lungs.

So far, so good. Ventilation = bulk movement of air.

Because the gas exchange is a separate process in respiration it is possible to have adequate ventilation and have poor blood gases.

Perhaps. The Pt may indeed have adequate ventilation and still be hypoxic. CO2 is far more diffusible than O2. So there may be inpaired gas exchange, but normal ventilation. Of course you may have a perfectly healthy person from a pulmonary stantpoint with a metabolic component reflected in the blood gas. (metabolic acidosis compensated [or partially compensated] for by hyperventilation.) [Kussmauls in DKA Pt's.]

Therefore, it is possible to assess the ventilation quality of a patients respiratory status independent from the blood gases.

NEVER! the ONLY measurement of ventilation is by CO2. Exhaled CO2 may be monitored, but like any non invasive measurement, its not as precise as (in this case) a blood gas. Again, the Pt's CO2 is the ONLY true measurement of ventilation. A Pt's WOB certainly may be visually assesed however.

It is true that the tachypneic patient is not necessarily hyperventilating. In my line of work the tachypneic patient is frequently hypoventilating and we can often correct this with use of opioids to depress the respiratory rate.

It seems you have your terminology mixed up a bit.....if your tachypneic Pt is indeed hypoventilating, supressing thier RR would not correct the hypercapnea it would make it worse. Administering an opiate to relieve dyspnea for a hospice/palliative care Pt will certainly reduce WOB and make them more comfortable.

[PageRespiratory!]

.....................Ventilation does not equal oxygenation......................Tacypnea: abnormal elevation of respiratory rate. (Notice no mention of depth of breaths or ventilation).....Bradypnea: abnormal decrease in respiratory rate (Again, no mention of ventilation)Hyperpnea: deep breathing (Notice no mention of rate or ventilation)....Hypopnea: Shallow breahing (No mention of rate or ventilation).....Hypercapnea: abnormal presence of excess amounts of CO2 in the blood.....Hypoventilation: ventilation less than necessary to meet metobolic needs, signified by a pCO2 greater than 45 mmHg in the arterial blood.....Hypocapnea: presence of lower than normal amounts of CO2 in the blood.....Hyperventilation: ventilation in excess of that necessary to meet metobolic needs, signified by a pCO2 less than 35mmHg in the arterial blood.....Kussmauls respiration: hyperpnea associated with DKA (notice kussmauls specifically associates with DKA).....Cheyene Stokes respiration: abnormal, repeating pattern of breathing characterized by alternating progressive hypopnea and hypoventilation ending in brief apnea. (Notice ventilation has been assesed, personally I've only seen this in TBI or otherwise neurologically compromised Pt's)Biots respiration: breathing characterized by irregular periods of apnea alternating with periods in which four or five breaths of identical depth are taken. (Notice no mention of ventilation, this Pt may have a perfect blood gas)

Source: EGANS Fundamentals of Respiratory Care, 9th edition.

[tewdles, RN]

PageRespiratory...I am not looking to correct CO2 when I administer opioids to slow respirations...opioids have a number of benefits in palliative care, as you noted. You have a critical care perspective...I understand that, I ran a PICU and critical transport team for many years. I lectured on blood gases in our region, particularly as related to care of the critically ill and injured child.

The point I am making is that it is possible for a person to assess ventilation without measuring CO2. You agreed that ventilation and blood gases may not be directly related...it is possible to have one WNL and one not so much. Certainly there are tests which can be done to further evaluate effectiveness of respiration, but they are not appropriate or available in all settings.

In the patient home, I assess their pulmonary status very carefully as my plan of care will be directed to making them more comfortable. If they are experiencing respiratory distress I must be able to determine what interventions will likely make them more comfortable. Clearly interventions will differ if I am looking at a ventilation problem (tachypnea, obstruction by tumor, etc) vs. a gas exchange problem. Certainly some poor folks have a mixed bag of sorrow when it comes to respiration.

This is not a right way vs. wrong way issue...this is a battle field and objective issue.

I appreciate your well informed posts.

[PageRespiratory!]

The point I am making is that it is possible for a person to assess ventilation without measuring CO2.

>Absolutely agree with everything excpet above quoted. An I'll admit I may be splitting hairs here, but "Ventilation" can only be assesed with a CO2 measurement. It seems to me WOB is what you're refering to. I often administer morphine to the dyspneic terminally ill Pt. and you're correct, CO2 (ventilation) is not a concern, easing thier WOB is what we're after. EGANS Fundamentals of Respiratory Care 9th edition, page 235: "Ventilation is determined by the partial pressure of CO2 and the resulting pH, specifically in the arterial blood. Ventilation is effective when the PaCO2 is maintained at a level that keeps the pH WNL." I definalely agree with you, this isn't "Right Vs. Wrong" it's more like "which term do you like better" LOL!

[tewdles, RN]

Back in the day, we considered ventilation the actual movement of air in the respiratory system. Poor movement = poor ventilation. Auscultating breath sounds was the first means to assess ventilation. Observation of the respiratory pattern and symptoms were also extremely important. A kid who had aspirated a lima bean and occluded his bronchus had bad ventilation and thus bad breath sounds. A flail chest had both visual and audible changes.

Back in the day we didn't have CO2 measurement outside of blood gases. Naturally ABGs were a big part of the equation for assessing the adequacy of ventilation in the acute care setting. We were thrilled when they wheeled in a machine of some 60+ pounds one day that would measure the CO2 noninvasively. The ability to measure some of these things without poking people changed the face of respiratory care and nursing assessment in the critical care setting.

So, when I listen to my patient and there are no breath sounds in the left lung, at all...and I know that this patient has a tumor just near the bronchus...you can bet this patient has a ventilation problem. I could get orders for ABGs and CXR to confirm and diagnose this, but in my practice setting that is not practical nor desireable. Does that mean that I was not able to assess his ventilation problem? Not really. If that guy is doing okay (gas wise) now with an increased rate, we both know that he will soon develop all of the symptoms of acidosis and hypercapnea and hypoxia. He has a ventilation problem which will quickly become a full respiratory problem.

So, in my mind, in the absence of fancy equipment we assess ventilation the way we did years ago...with our ears and eyes. The fact that respiratory care textbooks define ventilation according to blood gases is, of course, correct. But I know that a determination of ventilation can be made in the absence of blood gases as well....we can at least determine if the person is actually moving any air at all into the lungs...that in my mind, is ventilation at it's core...is there air actually moving(?). It may not be specific or scientific but...it is basic nursing.

Again, thank you for the thoughtful and well informed post.