Recognising Bradypnoea for Student Nurses
Learn how to recognise an abnormally slow respiratory rate, assess breathing and consciousness, and understand when reduced respiration may indicate serious patient deterioration.
What is bradypnoea?
Bradypnoea means breathing more slowly than expected. For many resting adults, a respiratory rate below around 12 breaths per minute is described as slow, although the significance depends on the patient's normal baseline, medications and clinical condition.
Breathing more slowly
A respiratory rate below 12 breaths per minute is commonly considered slow in a resting adult.
Is breathing effective?
Slow shallow breathing may be more concerning than slow but otherwise effective respiration.
Assess alertness
Drowsiness or reduced responsiveness alongside slow breathing can indicate significant deterioration.
How should you assess slow breathing?
Count accurately
Observe the patient's breathing and measure respiratory rate rather than relying on an estimate.
Assess depth
Look at whether breaths appear normal, unusually shallow or progressively weaker.
Assess consciousness
Check alertness and recognise any new drowsiness, confusion or reduced responsiveness.
Assess oxygenation
Review oxygen saturation, prescribed target range and any supplemental oxygen being used.
Review medication history
Consider medicines that may reduce respiratory drive, while avoiding assumptions about the cause.
Assess within ABCDE
Review airway, breathing, circulation, disability and exposure when significant deterioration is suspected.
Slow does not necessarily mean comfortable
A patient may appear quiet simply because their consciousness and respiratory drive are reduced. Assess rather than assuming they are resting comfortably.
Why might breathing become unusually slow?
| Possible context | Other clues | Clinical thinking |
|---|---|---|
| Sedating medication | Drowsiness, reduced alertness or recent medication administration. | Some medicines can depress respiratory drive and require appropriate clinical assessment. |
| Neurological deterioration | Reduced consciousness, abnormal behaviour or other neurological change. | Altered breathing can accompany significant neurological deterioration. |
| Severe hypothermia | Low temperature, bradycardia or reduced responsiveness. | Physiological processes may slow as hypothermia becomes more severe. |
| Exhaustion | A previously distressed patient becomes quieter with weaker breathing. | Apparent improvement can be misleading if respiratory effort is failing. |
| Central nervous system problem | New neurological signs, altered consciousness or clinical history. | Problems affecting respiratory control can alter breathing rate and pattern. |
| Critical deterioration | Falling oxygen saturation, reduced responsiveness or worsening circulation. | Bradypnoea in an unstable patient can be a serious late sign. |
Watch for the patient becoming quieter
A patient who was previously breathing rapidly and working hard but is now breathing slowly, shallowly and becoming drowsy may be worsening rather than improving.
Signs that increase concern
- Respiratory rate is progressively falling.
- Breathing becomes shallow or less effective.
- The patient is increasingly drowsy.
- They are difficult to wake or less responsive than previously.
- Oxygen saturation is falling.
- The airway appears threatened or breathing sounds become abnormal.
- Pulse or blood pressure is also deteriorating.
- There has been recent sedation, opioid use or another relevant medication.
- The patient has experienced a neurological event or head injury.
Do not mistake exhaustion for improvement
28 breaths/min
Patient working hard to breathe and showing respiratory distress.
18 breaths/min
A lower rate might appear reassuring, but reassess breathing effort, oxygenation and alertness.
8 breaths/min
Slow shallow breathing with increasing drowsiness represents a significant deterioration pattern.
The number can move in the βrightβ direction for the wrong reason
A respiratory rate falling from very high to very low does not necessarily mean recovery. Always reassess the patient's breathing effectiveness and level of consciousness.
Putting the observations together
Example
A patient was previously alert with a respiratory rate of 18 breaths per minute.
Following treatment that includes sedating medication, you notice that they are much more difficult to wake.
Their respiratory rate is now 8 breaths per minute and the breaths appear shallow.
Their oxygen saturation is also falling.
The concern is the combined pattern of bradypnoea, reduced consciousness and worsening oxygenation.
As a student nurse, recognise this as potentially serious deterioration and seek urgent registered or emergency support according to local procedure.
Bradypnoea assessment errors to avoid
- Assuming slow breathing means the patient is relaxed. Assess consciousness and breathing depth.
- Looking only at oxygen saturation. Respiratory failure can develop despite initially preserved SpOβ.
- Ignoring medication history. Sedating medicines can affect respiratory drive.
- Failing to recognise exhaustion. A struggling patient becoming quieter may be deteriorating.
- Ignoring airway assessment. Reduced consciousness can increase airway risk.
- Delaying escalation. Very slow breathing with altered consciousness can be an emergency.
Recognise β assess β communicate β escalate
Notice slower breathing
Identify bradypnoea, shallow respirations or a meaningful change from the patient's previous breathing pattern.
Check effectiveness
Review airway, respiratory depth, oxygenation, consciousness and the wider ABCDE picture.
Act promptly
Report respiratory rate, depth, consciousness and associated deterioration clearly.
Recognising Increased Work of Breathing for Student Nurses
Learn how to recognise accessory muscle use, laboured breathing, difficulty speaking and other signs that a patient is working harder to breathe.
Continue to Increased Work of Breathing β