Adult tachypnea

Specialty: Respiratory.

• rapid breathing in adults
• high respiratory rate
• superficial polypnea

Why it occurs

• Bacterial, viral or atypical pneumonia (due to compromise of the lung parenchyma and activation of chemoreceptors due to hypoxia and inflammatory mediators)
• Acute pulmonary thromboembolism (PTE) (caused by occlusion of the pulmonary vasculature that alters the ventilation/perfusion relationship and generates reflex hyperventilation)
• Acute asthma attack or COPD exacerbation (as a mechanical response to compensate for airflow limitation and gas trapping)
• Acute pulmonary edema (APE) of cardiogenic or non-cardiogenic origin (due to fluid accumulation in the alveolar space that reduces lung compliance)
• Severe metabolic acidosis (respiratory compensatory mechanism to eliminate carbon dioxide and normalize blood pH, as in diabetic ketoacidosis or renal failure)
• Sepsis or systemic inflammatory response (direct stimulation of the bulbar respiratory center by inflammatory cytokines)

Initial workup

Direct visual measurement of respiratory rate for at least one full minute; continuous pulse oximetry; analytical arterial blood gas; Digital chest x-ray; Chest CT angiography (if there is clinical suspicion of thromboembolism); Complete blood analysis with acute phase reactants (CRP, procalcitonin), complete blood count, serum lactate and electrolytes.

Standard management

• Salbutamol — nebulized, 2.5-5 mg diluted in saline every 20 minutes during the first hour in obstructive crises
• IPratropium bromide — nebulized, 0.5 mg combined with bronchodilator treatment
• Methylprednisolone — administered at a dose of 40 mg intravenously every 12 hours in asthmatic or COPD exacerbations
• Oxygen therapy with a Venturi mask (adjusted to the inspired fraction of oxygen required).