Detrimental or Just Different Respiratory Drive

Jerry and Paula will tell you that there are advantages to having different respiratory drive;

advantages [tendency to survive respiratory infections and spontaneously recover, though without supportive medical support, recovery may take months, years or even decades]

and

disadvantages [long periods of different motor subtypes of delirium, depending on PCO2 levels in the blood]. Physiology of the Respiratory Drive in ICU Patients: Implications for Diagnosis and Treatment
Annemijn H. Jonkman, Heder J. de Vries & Leo M. A. Heunks 
Critical Care volume 24, Article number: 104 (2020) https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-2776-z

And, as we have previously mentioned, Dr Emile Kraepelin found too slow breathing at rest in thousands of unmedicated patients suffering from reversible attacks of depressive insanity and too fast and chaotic breathing at rest in the same patients in stages of manic insanity. The type of insanity and the affect on locomotor activity seemed to be linked to the abnormal breathing at rest set by the autonomic nervous system and/or the brain stem.

Maybe keeping acid base status of the blood as normal as is possible is the reason for the abnormal resting respiratory rate or maybe a problem with the respiratory pump is responsible. This needs to be studied further, I think.

Dr. Kraepelin was not the first to notice different or detrimental respiratory drive in both neurologic and neuropsychiatric patients. Dr Ronald Christie [famous lung doctor and scientist] also commented on the frequency of abnormal breathing in these patients. Unfortunately, no one since Dr. Kraepelin, thought to treat this seriously in fields other than respiratory medicine. The reason for this, we think, is that the respiratory pump [the rib cage, the spine, diaphragm, and other respiratory muscles], the lung, and the makeup of the blood are very hard to understand and both the neurologists and the psychiatrists chose to focus on other things. This was and remains unfortunate for their patients.

Abnormal respirations at rest can lead to hypercapnia or hypocapnia with resulting reversible mental confusion. No one to date has studied the partial pressure of oxygen or carbon dioxide in the blood in seriously depressed, mixed, or manic unmedicated patients even though abnormal breathing at rest might be causing abnormal brain and mind function. We can study this in the 21st century. We can treat this in the 21st century. Mental Confusion is either very very unpleasant and distressing [causing anguish] or can be intoxicating as in euphoria, making one as disabled as if on a stimulant recreational drug-but involuntarily so.

There are multiple types of normal and abnormal respiration. They include apnea, eupnea, orthopnea, dyspnea, hyperpnea, hyperventilation, hypoventilation, tachypnea, Kussmaul respiration, Cheyne-Stokes respiration, sighing respiration, Biot respiration, apneustic breathing, central neurogenic hyperventilation, and central neurogenic hypoventilation. Each pattern is clinically important and useful in evaluating patients.

Evaluating respiratory patterns assists the clinician in understanding the patient’s current physiologic status. Abnormal breathing patterns suggest the possibility of an underlying injury or metabolic derangements. Early recognition of abnormal respiratory patterns can aid the clinician in early intervention to prevent further deterioration of the patient’s condition.

Breathing is controlled centrally in the brainstem.” Abnormal Respirations, Lacey Whited; Derrel D. Graham. https://www.ncbi.nlm.nih.gov/books/NBK470309/ StatPearls. Last Updated April 2020.

[I will continue later…..it is fascinating…]………………

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