Continuing Education Activity

Tachypnea is defined as a breathing rate that is higher than the normal breathing rate. This condition is seen in both the physiologic state as well as as a symptom of pathology. This activity reviews the evaluation and management of tachypnea and highlights the interprofessional team's role in collaborating to provide well-coordinated care and enhance patient outcomes.

Objectives:

• Identify the etiology of tachypnea.
• Outline the typical presentation of a patient with tachypnea.
• Review the risk factors for developing tachypnea.
• Summarize the importance of improving care coordination amongst interprofessional team members to improve outcomes for patients with tachypnea.

Introduction

Tachypnea is a condition that refers to rapid breathing. The normal breathing rate for an average adult is 12 to 20 breaths per minute. In children, the number of breaths per minute can be a higher resting rate than seen in adults. 

Etiology

Tachypnea does not necessarily have a pathological cause. For example, exercise can cause tachypnea. Some pathological causes of tachypnea are sepsis, diabetic ketoacidosis, respiratory issues such as pneumonia, carbon monoxide poisoning, pulmonary embolism, pleural effusion, asthma, or chronic obstructive pulmonary disease (COPD). Other medical issues such as allergic reactions, anxiety states, and foreign body aspiration can also cause tachypnea.[1][2]

Epidemiology

Tachypnea in newborns is a problem with the respiratory system that can become apparent shortly after delivery. It can result from impaired clearance of fetal lung fluid, which leads to respiratory distress. Transient tachypnea of the newborn has a higher prevalence in preterm infants. It occurs in approximately 1 in 100 preterm infants, whereas, in term infants, it presents in about 4 to 6 per 1000 infants.[3][4]

Tachypnea in adults is breathing more than 20 breaths per minute. Twelve to twenty breaths per minute is a normal range. 

Pathophysiology

Tachypnea is a term used to define rapid and shallow breathing, which should not be confused with hyperventilation, which is when a patient's breathing is rapid but deep. Both are similar in that both result from a buildup of carbon dioxide in the lungs, leading to increased carbon dioxide in the blood.[5]

This buildup of carbon dioxide in the blood makes the blood more acidic than usual, alerting the brain. In response, the brain signals the respiratory drive to increase in pace in an attempt to correct the imbalance. In doing so, the blood pH can return to within the normal range in acidity.

History and Physical

Patients may present with complaints of feeling short of breath. They also may say that they do not feel as if they can get in enough air. On physical exam, patients may have blue-tinged fingers or lips and/or use of accessory muscles or chest muscles to breathe. On the other hand, patients can present without any obvious symptoms. 

In newborns, tachypnea can be due to fluid retention in the lungs within the first 24 hours of birth. Infants can present with a blue color in the perioral area, grunting or signs of difficulty breathing, retraction of the chest while breathing, bobbing of the head, and/or flared nostrils.[6][7]

Evaluation

The evaluation and cause of tachypnea are dependent on the patient's general disposition. Providers can evaluate based on oximetry, arterial blood gases, chest x-ray, chest CT, pulmonary function tests, glucose, electrolytes, hemoglobin, EKG, VQ scan, brain MRI and/or a toxicology screen. 

Arterial blood gases give an estimate of oxygen and carbon dioxide content, which can help determine the pH and metabolic abnormalities. If the pH indicates acidosis, some potential causes are diabetic ketoacidosis, lactic acidosis, or hepatic encephalopathy.[8] A blood sugar, if taken, can indicate or rule out diabetic ketoacidosis as well.[9][10]

A chest X-ray can depict any pulmonary causes of tachypnea, such as pneumothorax, cystic fibrosis, or pneumonia.[11] A chest CT, which shows greater detail, can indicate any other lung pathologies or potential malignancies. Apart from imaging, pulmonary function tests can help determine causes resulting from obstructive lung diseases such as COPD or asthma. VQ scans can be helpful if signs and symptoms point to a potential pulmonary embolus.[12] If tachypnea is due to cardiac abnormalities, an EKG will show evidence of a heart attack or abnormal heart rhythms.[13][14]

A complete blood count and complete metabolic panel can indicate any evidence for anemia or infections, which can potentially cause tachypnea. A toxicology screen can determine if any drugs, both prescription or non-prescribed, may be causing tachypnea. 

Treatment / Management

Tachypnea should be treated depending on the underlying cause. 

If infants present due to transient tachypnea of the newborn, they can receive treatment with extra oxygen and, in some cases, may require some time in the neonatal intensive care unit.[7]

If the tachypnea is due to asthma or COPD, patients can receive an inhaled medicine to dilate and expand the alveoli in obstructive lung disease. If tachypnea is due to pneumonia, antibiotics are indicated to treat bacterial pneumonia, but viral pneumonia can be treated supportively without antibiotics.[15]

Differential Diagnosis

While tachypnea refers to rapid, shallow breathing, other conditions can also be mistaken for tachypnea as they may present similarly. Hyperpnea refers to both rapid and deep breathing, and dyspnea indicates the sensation of shortness of breath.

Prognosis

Tachypnea may be concerning for patients, but it is not always indicative of a critical illness. Though patients often require the advice of a medical professional, there are a variety of causes, and some may need immediate medical care. 

Complications

While tachypnea can result from physiological causes such as exercise, there are pathologic causes that may be of concern. The complications that arise from these pathologic causes are ones that clinicians should be aware of as they can lead to worsening physical exam and patient care outcomes.

Tachypnea can be a symptom of sepsis or acidosis, such as diabetic ketoacidosis or metabolic acidosis. Patients with lung problems such as pneumonia, pleural effusion, pulmonary embolism, COPD, asthma, or an allergic reaction also present with tachypnea.[16] Congestive heart failure can also be a cause of tachypnea and, if not managed, can progress to worsening heart failure. 

Anxiety states and hyperventilation during panic attacks would lead to tachypnea and can lead to hypocapnia or reduced carbon dioxide levels, reducing respiratory drive.

Deterrence and Patient Education

Patients should receive reassurance that tachypnea may not always indicate a serious medical illness. Patient education regarding the cause behind the patient's tachypnea is crucial. Patient's understanding of their condition can help in proper management and follow-up. 

If there are any concerns, the safest course of action would be to seek medical advice urgently to ensure diagnostic workup and treatment promptly. 

Enhancing Healthcare Team Outcomes

As expected, the best possible outcomes for patient care involve an integrated and interprofessional team approach that includes an internist, nurse practitioner, pulmonologist, intensivist, and laboratory specialist. If a patient is seen to be tachypneic, the role of the clinical physical exam, imaging, and laboratory values are significant. The patient should not be discharged until the tachypnea has resolved and consultations or referrals occur as deemed necessary. Healthcare professionals should discuss amongst themselves any significant complications or comorbidities. 

Collaboration and teamwork, as well as communication, are necessary for good outcomes and prognosis. This collaboration should involve the entire interprofessional team, including all physicians, specialty-trained nurses, pharmacists, and respiratory therapists, using an integrated and evidence-based approach to determining the plan and treatment leading to optimal patient care and outcomes. [Level 5]