Agonal respiration, gasping respiration or agonal breathing is a distinct abnormal pattern of
breath
Breathing (or ventilation) is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen.
All aerobic creatures need oxygen for cell ...
ing and
brainstem reflex characterized by gasping, labored breathing, accompanied by strange vocalizations and
myoclonus
Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus (myo "muscle", clonic "jerk") describes a medical sign and, generally, is ...
.
Possible causes include
cerebral ischemia
Brain ischemia is a condition in which there is insufficient bloodflow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and thus leads to the death of brain tissue or cerebral infarction/ischemic stroke. ...
, extreme
hypoxia (inadequate oxygen supply to
tissue),
or even
anoxia (total depletion of oxygen). Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete
apnea and heralds
death
Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
. The duration of agonal respiration can be as brief as two breaths or last up to several hours.
The term is sometimes (inaccurately) used to refer to labored, gasping breathing patterns accompanying organ failure (e.g.
liver failure and
kidney failure
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...
),
SIRS,
septic shock, and
metabolic acidosis
Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys ...
(see
Kussmaul breathing
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is a form of hyperventilation, which is any breathing pattern that red ...
, or in general any labored breathing, including
Biot's respirations and
ataxic respiration
Ataxic respiration is an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. As the breathing pattern deteriorates, it merges with agonal respiration.
Cause
It ...
s). Correct usage would restrict the term to the last breaths before death.
Agonal respirations are also commonly seen in cases of
cardiogenic shock or
cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and poss ...
, where agonal respirations may persist for several minutes after cessation of heartbeat.
The presence of agonal respirations in these cases indicates a more favorable prognosis than in cases of cardiac arrest without agonal respirations. In an unresponsive, pulseless patient in cardiac arrest, agonal gasps are not effective breaths. Agonal respiration occurs in 40% of cardiac arrests experienced outside a hospital environment.
References
External links
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Gasping, even the dead breatheReal footage of a person with cardiac arrest and terminal breathing (gasping)
Breathing abnormalities
Medical emergencies
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