From the Guidelines
Tripod breathing, also known as tripod positioning, is a compensatory mechanism employed by patients with severe respiratory distress, typically caused by conditions such as chronic obstructive pulmonary disease (COPD), pneumonia, or pulmonary embolism 1. This breathing pattern is characterized by the use of accessory muscles, including the sternocleidomastoid and scalene muscles, to facilitate inhalation.
Causes of Tripod Breathing
The underlying cause of tripod breathing is often related to increased work of breathing, which may be exacerbated by factors such as:
- Bronchospasm
- Airway obstruction
- Respiratory muscle fatigue These conditions may lead to low lung compliance, requiring the use of accessory muscles to generate more negative intrapleural pressures during inspiration 1.
Management of Tripod Breathing
Tripod breathing may be managed with medications such as bronchodilators, including:
- Albuterol (2.5-5mg via nebulizer every 4-6 hours)
- Ipratropium (500mcg via nebulizer every 6 hours) Additionally, palliative care measures such as regular assessment and reassessment, opioids, counseling, and care coordination can provide relief from dyspnea 1.
Key Points
- Tripod breathing is a compensatory mechanism for severe respiratory distress
- Causes include COPD, pneumonia, and pulmonary embolism
- Accessory muscles are used to facilitate inhalation
- Management includes bronchodilators and palliative care measures
- Increased work of breathing and low lung compliance contribute to the development of tripod breathing 1
From the Research
Causes of Tripod Breathing
The causes of tripod breathing, also known as orthopnea or respiratory distress, can be attributed to several factors, including:
- Respiratory muscle dysfunction, which is common in patients with chronic obstructive pulmonary disease (COPD) 2
- Dynamic hyperinflation of the rib cage and impaired gas exchange 3
- Increased elastic loading of the inspiratory muscles in recumbency, associated with increased inspiratory neural drive and greater neuromechanical dissociation of the respiratory system 4
- Lung hyperinflation and severe airflow obstruction, which can lead to an unpleasant respiratory sensation at rest, further amplified by adoption of a supine position 4
Mechanisms of Orthopnea
The mechanisms of orthopnea in patients with advanced COPD are poorly understood, but studies suggest that:
- Orthopnea is associated with acute changes in inspiratory neural drive, neuroventilatory uncoupling, and neuromechanical dissociation of the respiratory system 4
- The supine position can lead to a decrease in dynamic lung compliance and an increase in breathing discomfort, inspiratory work of breathing, and inspiratory effort in patients with COPD 4
- Body positioning and diaphragmatic breathing exercises can alter respiratory pattern and reduce dyspnea in people with COPD, but the effects may be transient and dependent on individual factors such as nutritional status 5
Respiratory Muscle Function
Respiratory muscle function plays a crucial role in the development of tripod breathing, with studies showing that:
- Improving dynamic function of respiratory muscles during exercise may help reduce symptoms and improve exercise capacity in patients with COPD 2
- Diaphragmatic muscle activity can be improved with diaphragmatic breathing exercises, but the effects may be short-lived and dependent on individual factors such as nutritional status 5
- Intercostal muscle activity may not be significantly affected by positioning or diaphragmatic breathing exercises in patients with COPD 5