Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea. Gasping respiration is also referred to as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated. We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death.
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http://dx.doi.org/10.1136/jme.28.3.164 | DOI Listing |
Resuscitation
January 2025
Department of Pediatrics, POB 8100 4068, Stavanger, Norway, Stavanger University Hospital and University of Stavanger; Department of Anaesthesiology & Intensive Care, Stavanger University Hospital, POB 8100 4068, Stavanger, Norway. Electronic address:
Background: The impact and/or significance of gasping or apnea on cardio-respiratory status at birth remains unclear.
Objectives: The study objectives were to determine in infants presenting with gasping or apnea in the delivery room, initial heart rate (HR), responses to positive pressure ventilation (PPV), time to onset of spontaneous respirations, and the relationship of these responses to 24-hour outcome (death/survival) METHODS: Observation study undertaken in a rural setting involving late preterm and term newborns who gasped (n=126) or were apneic (n=105) at birth and received PPV had HR and respiratory parameters continuously measured and were video recorded.
Results: Apneic (12.
Respir Physiol Neurobiol
January 2025
Department of Anesthesiology, Graduate School of Medicine, Chiba University, Japan.
J Neurophysiol
October 2024
Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States.
Ann Ib Postgrad Med
April 2024
Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Nigeria.
Introduction: The white cerebellum sign (WCS) is a classical but rare radiological finding usually associated with irreversible diffuse hypoxic-ischemic cerebral injury. Very few cases exist in the literature globally, especially from the West African region, as a potential hallmark of poor prognostic outcome. We describe the white cerebellum sign in a Nigerian pediatric patient, managed for severe head injury.
View Article and Find Full Text PDFBrain Behav Immun
July 2024
Division of Neuropathology, Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States. Electronic address:
Neonatal sepsis remains one of the leading causes of mortality in newborns. Several brainstem-regulated physiological processes undergo disruption during neonatal sepsis. Mechanistic knowledge gaps exist at the interplay between metabolism and immune activation to brainstem neural circuits and pertinent physiological functions in neonates.
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