# The difference between hyperventilation, hyperpnea, and tachypnea



## MySandie (Jun 29, 2013)

Hey all, on a very old thread, I read:




KEVD18 said:


> I guess vent didn’t make his point clearly enough, so I'll give a it another shot:
> 
> HYPERVENTILATION IS NOT THE SAME AS TACHYPNEA! They are not interchangeable terms.
> 
> ...



It seems to me that only the EMTs know what the hell is going on!  

So, would one of you please help me out here, and explain how/why I am getting so confused by these terms-so I can untangle my weary brain.  I suspect it has something to do with the differences between the "Physiology of Respiration" versus the typical body system physiology in general.

*ME*:  Nursing student, taking NCLEX-RN boards next week, and I have the following knowledge base:

Ventilation is defined as the mechanical process of *breathing* (inspiration & expiration), 'respiration' is defined as the chemical process of *gas exchange* (esp. O2 and CO2);  'internal respiration' means gas exchange at the cellular level between vessels & cells

*AND*

The Greek suffix 'pnea' means "air (gas)"; prefix 'tachy' means "rapid/fast"; and 'hyper' means "over/excessive"

*AND*

1.  tachypnea = "rapid ventilation" (breathing)
2.  hyperpnea = "deep ventilation-with or without increased rate" (vs. Kussmaul's = rapid *+* deep)
3.  hyperventilation doesn't seem to really HAVE a definition, but seems to mean "a decrease in PaCO2 and increase in O2, resulting in hypocapnia".  (Why isn't it defined as "over/excessive *breathing*"?  Answer: because it would make too much sense!?  

*THEN*

Shouldn't the term 'hyperventilation' instead be termed, 'hyper-respiration' or even better yet: 'hyperpnea' (excessive gas/air) to be more medically correct?  Especially since 'hyperventilation' and 'tachypnea' seem to be terms that are commonly interchanged--albeit, wrong....even by physicians.

Sorry...I don't mean to be so darn literate, but it's the way I study and memorize/learn medical concepts (esp. pharmacology) so that if I don't know a specific term, I can break down the word to it's root meaning in order to figure out the classification of meds.  My confusion started when I was reviewing the differences between how cholinergic and anticholinergic drugs affect the sympathetic and parasympathetic nervous system.  So I started an internet search and became even more confused!  I ran into different nursing and medical sites that interchanged the definitions of tachypnea with hyperventilation, as well as ventilation with respiration...often times in the same paragraph.

Any help would be appreciated!


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## Craig Alan Evans (Jun 29, 2013)

It sounds like you understand it all quite well. You just would like the terms to be used consistently so it will be easier to understand by breaking the words down.


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## MySandie (Jun 29, 2013)

Thanks, Craig.
So...if I DO have it all correct, then the problem seems to be not in my lack of understanding, but more of an emotional response to lack of consistency when reading medical literature, which, ultimately leads to increased confusion.

Perhaps I have hyperventilation syndrome!  

Maybe I should just try substituting what I think is the correct term when reading the literature to see if it all comes together.  Right now, though it may appear as if I understand...it's tenuous, at best!


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## VFlutter (Jun 29, 2013)

MySandie said:


> It seems to me that only the EMTs know what the hell is going on!


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## Akulahawk (Jun 29, 2013)

Chase said:


>


That's only because you were empty (EMT) before you got Nursed... :rofl:

Sorry... couldn't resist!


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## MySandie (Jun 29, 2013)

Akulahawk said:


> That's only because you were empty (EMT) before you got Nursed... :rofl:
> 
> Sorry... couldn't resist!


@ Akulahawk:  love it!  Too funny.  Thanks, I needed that comic relief.

@ Chase:  I meant no offense to RNs when I wrote, "It seems to me that only the EMTs know what the hell is going on".  But, after spending >2 hours googling: 'The difference between tachypnea, hyperventilation and hyperpnea'--then browsing several nursing sites/posts, and reading a few research articles by MDs, THIS site for EMTs gave me the only clear starting point towards untangling my weary brain!

So, bravo to being empty (EMT)!


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## Christopher (Jul 1, 2013)

MySandie said:


> Shouldn't the term 'hyperventilation' instead be termed, 'hyper-respiration'...



No. The rate of cellular respiration is not necessarily increased.



MySandie said:


> ...or even better yet: 'hyperpnea' (excessive gas/air) to be more medically correct?...



No, because that is merely increased volume. It isn't used to describe the increase in alveolar ventilation.



MySandie said:


> Especially since 'hyperventilation' and 'tachypnea' seem to be terms that are commonly interchanged--albeit, wrong....even by physicians.



Ok. I don't think we run into too many problems because of this. Perhaps for testing purposes.


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## savemachine (Jul 1, 2013)

The wording all makes sense to me, of course it is difficult to change the terminology in the world of medicine already.




MySandie said:


> Hey all, on a very old thread, I read:
> 
> 
> 
> ...


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## savemachine (Jul 1, 2013)

I mean: the wording YOU are suggesting



savemachine said:


> The wording all makes sense to me, of course it is difficult to change the terminology in the world of medicine already.


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## Summit (Jul 1, 2013)

Akulahawk said:


> That's only because you were empty (EMT) before you got Nursed... :rofl:
> 
> Sorry... couldn't resist!



Had I been drinking milk, it would be coming out my nose from laughing. :rofl:


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## ThadeusJ (Jul 2, 2013)

As Christopher mentions above, "respiration" actually refers to what's going on at the cellular level, which is why Respiratory Therapists insist that we place patients on "ventilators" and not "respirators". That being said, the very learned healthcare practitioners in the UK and elsewhere use respirators.  Yet we still document respiratory rate (things that make you go, "hmmmm")...

This is a great example of ensuring that you chart in a way that allows for different interpretations from different practitioners.  Its also a great example of why one doesn't absorb textbook and Internet information as the absolute gospel (because a lot of it is miss-interpreted or just plain wrong).


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## Clipper1 (Jul 2, 2013)

MySandie said:


> 3.  hyperventilation doesn't seem to really HAVE a definition, but seems to mean "a decrease in PaCO2 and increase in O2, resulting in hypocapnia".  (Why isn't it defined as "over/excessive *breathing*"?  Answer: because it would make too much sense!?
> 
> *THEN*
> 
> Shouldn't the term 'hyperventilation' instead be termed, 'hyper-respiration' or even better yet: 'hyperpnea' (excessive gas/air) to be more medically correct?  Especially since 'hyperventilation' and 'tachypnea' seem to be terms that are commonly interchanged--albeit, wrong....even by physicians.



This might seem confusing now but once you start working as an RN and start dealing with many different disease processes you will understand this better.

Hyperventilation is taught in EMT class almost like a stand alone process without defining many of the causes except for anxiety.   In many situations it is an issue of surviving for the body to correct itself to maintain homeostasis or adequate acid base balance.   Also, when you start looking at ABGs (Arterial Blood Gases), even thought the definition of hyperventilation is a low PaCO2, you will start thinking in termed of compensated, partially compensated and uncompensated Metabolic or Respiratory acidosis and alkalosis.  You will also go on further to recognize gap and non gap acidosis before you look silly suggesting NaHCO2. ABGs alone still only give a small snap shock of a bigger picture.  

The rest of the definition of a true "hyperventilation" would be an ABG which shows Respiratory Alkalosis with a lowered PaCO2 and without evidence of another medical condition.

It is difficult to call someone who has a Pulmonary Emboli as "hyperventilating" as a stand alone condition even though the initial appearance, SpO2 and sometimes PaO2 might appear that way.  The person has tachypnea trying to move enough MV in hopes of maintaining oxygenation.

The same would be for someone who is septic with an increased lactate level. As you get more experience as a nurse you will not look at this person who might also have a temp of 104 with cool skin, low BP and rapid respiratory rate and say "hyperventilating" even though the initial ABG might appear like that, another one might show a profound metabolic acidosis.

DKA is another example and the Kussmaul's breathing which can not only be deep but also rapid. That is survival with the body trying to get the pH higher. 

Head injuries (CVA, trauma) may also "hyperventilate" but the context of the term should purely be focuses on the reason causing the increased breathing. Yes, the body may also use "hyperventilation" as a survival mechanism early in a head injury but it may also give a clue to where the injured area is or what is occurring and intervention is necessary. 

COPD patients can have tachypnea but on their ABG, the PaCO2 will be rising. 
The same for kids.  This means respiratory failure is knocking hard.  Asthmatics can also present this way and are even mistaken on initial appearance as "just hyperventilating" because they are anxious, have a good SpO2 and may even have no wheezes.  

Obese patients may breathe fast (tachypnea) but also hypoventilate and will often have a chronically high PaCO2 level.

Now, to confuse the situation more, can a CO2 retainer with chronically elevated PaCO2 and HCO3 from either COPD, obesity or neuromuscular disease, hyperventilate?  The answer is yes and sometimes confusing unless you look at the other lab values to see what possibly raised the pH level.


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## Clipper1 (Jul 2, 2013)

ThadeusJ said:


> As Christopher mentions above, "respiration" actually refers to what's going on at the cellular level, which is why Respiratory Therapists insist that we place patients on "ventilators" and not "respirators". That being said, the very learned healthcare practitioners in the UK and elsewhere use respirators.  Yet we still document respiratory rate (things that make you go, "hmmmm")...



How big in the UK is ECMO?  The term "respirator" went out of favor in the US when the heart/lung bypass and ECMO became more prominent.  ECMO has been around in the US since the 70s while it seems the UK did not start using it until around 1990.   

The ECMO patients are usually hooked up to both a ventilator and the ECMO machine. If the ventilator could do what a respirator does then  ECMO would not be needed.  It is easy to see the difference when they are side by side which is why the US did change its terminology.   Even British doctors have had to relearn the terms especially if they were to work in an ICU with both machines.


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## ThadeusJ (Jul 2, 2013)

ECMO is used in the UK, but I can't say if its at the same level as North America.  I hosted a perfusion simulation lab during an international conference in Toronto a few years ago and we had practitioners from all over, but the USA had the bulk of the registrants.

Even the Bird Mark VII was called a respirator at the time but as you say the terminology was eventually changed.  I suppose one can say that the new(er) modality of therapeutic hypothermia after a cardiac arrest is designed specifically to decrease the actual respiratory rate separate from the ventilatory rate, which may place some context to the original question.  

I suppose one has to really look at the definition of something and understand what its defining in order to question the validity of the term.  For example the common definition of veins vs arteries (oxygenated vs de-oxygenated blood) doesn't always fit when you consider the pulmonary vasculature.  Likewise, there are several definitions of acid due to exceptions and the evolution of science.  Even the term "vitamin" came from a combination of "vital" and "amine" before they realized that not all vitamins are amine based molecules.  Likewise, hyperventilation, tachypnea and hyperpnea may have regionalized definitions depending on who is using them and why.  I'll stop blabbing now...


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## Clipper1 (Jul 2, 2013)

ThadeusJ said:


> Even the Bird Mark VII was called a respirator at the time but as you say the terminology was eventually changed.  I suppose one can say that the new(er) modality of therapeutic hypothermia after a cardiac arrest is designed specifically to decrease the actual respiratory rate separate from the ventilatory rate, which may place some context to the original question.
> 
> ...



Yes the Bird Mark VII along with the MA 1 were initially called respirators in the US also back in the 70s. Hard to believe those machines are that old.  But, ECMO is now in Adult, pedi and neonatal units here in the US and very active in use.  Transport ECMO is also more readily available for all ages.

Sometimes with therapeutic hypothermia the ventilator rate might even be increased depending upon the amount of down time, lactate levels, pressors and fluids. If the patient is in failure and an over aggressive fluid management was done, a shift  to slightly higher PEEPs and higher rate with small volume might be used. 

There of course could also be a big discussion on affects of "hyperventilation" for vasculature in the pulmonary, cardiac and cerebral systems but then again the disease process is driving the initiation of hyperventilation by either the body or those intervening.

For this reason, it is difficult to give a precise answer to the OP's question unless there is a well known understanding of all the variations in disease processes and treatment.  Some things are just not clear cut A, B and C.


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