Agonal respiration is an abnormal pattern of breathing characterized by shallow, slow (3-4 per minute), irregular inspirations followed by irregular pauses. They may also be characterized as gasping, labored breaths, accompanied by strange vocalizations and myoclonus. The cause is due to cerebral ischemia, due to extreme hypoxia or even anoxia. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death.

Agonal respirations are also commonly seen in cases of cardiac arrest, and may persist for several minutes after cessation of heartbeat. The presence of agonal respirations in these cases indicates a more favorable prognosis than in cases of cardiac arrest without agonal respirations.

Agonal respiration is not the same as, and is unrelated to, the phenomenon of death rattle. The term is sometimes (inaccurately) used to refer to labored, gasping breathing patterns accompanying organ failure (e.g. liver failure and renal failure), SIRS, septic shock, and metabolic acidosis, or in general any labored breathing, including Biot’s respirations and ataxic respirations. Correct usage would restrict the term to the last breaths before death.

• Cheyne-Stokes Respiration

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