Paradoxical breathing: symptoms, causes and treatment


Paradoxical breathing is a symptom of a respiratory disorder associated with damage to the structures involved in breathing.

Instead of stretching out as you inhale, the chest or abdominal wall moves inward. Often the chest wall and abdominal wall move in opposite directions with each breath.

To understand the meaning of paradoxical breathing, it is important to first understand why it is a paradox.

Paradoxical breathing, often called paradoxical breathing, is essentially the opposite of what you would expect from breathing.

The physiology of respiration consists of two distinct parts: ventilation and respiration. Ventilation refers to the movement of air in and out of the lungs. Respiration refers to the exchange of gases between the lungs and the bloodstream.

Paradoxical respiration refers to changes in the mechanics of respiration, which is ventilation, not respiration. Learn more about the symptoms, causes, diagnosis, and treatment of this condition.

Get Medication Information / Gary Foerster


Paradoxical breathing is itself a sign (or symptom). The presence of paradoxical respiration indicates various types of respiratory failure or respiratory failure. The manifestation of paradoxical breathing depends on its cause.

Trauma can cause movements in the middle of the chest wall or in the back that are not consistent with what is happening along the rest of the chest wall. Medical causes of paradoxical breathing often result in vibrations between the abdominal wall and the chest wall when breathing .

Different breathing patterns cause different types of paradoxical breathing.


Traditionally, paradoxical breathing has been attributed to an injury and a medical cause. However, almost any cause of shortness of breath, if severe enough, can lead to paradoxical breathing.

For one reason alone, this paradoxical breathing is itself a diagnostic sign.

Chest of Flails

The most common cause of paradoxical breathing observed in the literature is called a chain chest , which consists of a free-floating segment of a chest due to multiple rib fractures.

A minimum of four complete rib fractures are required to form a flagellation segment, which is defined as two or more successive ribs, each fractured in two or more locations.

Some sources suggest that at least three adjacent ribs must be broken to be considered a flail segment. It is not so much the number of ribs involved, but the size of the segment .

The more area the unstable segment covers, the more severe the patient's shortness of breath.

Flail Chest is a very rare condition. In a study of 25,467 trauma patients admitted over a six-year period, only 85 patients had an unstable segment, about 1/3 percent .

The force required to fracture a rib is significant. To create a flagellum segment, this level of force must be applied to a much larger area and break the entire portion of the ribs away from the adjacent rib cage.

This force can damage more than just the chest. Many chain sinus patients also have associated internal injuries.

The movement of the free-floating flail segment is paradoxical in that it pulls inward when you inhale and swells when you exhale. This movement is the opposite of the rest of the chest.

The movement of the large flail segment minimizes the effectiveness of your breathing attempts. It is difficult to expand the rib cage to allow air to enter because the segment moves inward and reduces the change in the total volume of the chest. The same thing happens when you exhale.

In the chest, paradoxical breathing can lead to complications such as pneumothorax and pneumonia.

Diaphragm paralysis

Paradoxical breathing, which can be caused by trauma or medication, is caused by paralysis of the diaphragm .

In this rare condition, the diaphragm can become paralyzed or weakened due to injury to the spinal cord or for medical reasons that directly affect the muscle or nerves that lead from the brain to the diaphragm .

The diaphragm is a bulging muscle at the base of the chest cavity that separates it from the abdomen. The diaphragm is extremely important for breathing. It is the muscle that most participates in the expansion and contraction of the chest to change volume when inhaling or exhaling.

When the diaphragm is weak enough, the muscles of the chest wall, the intercostal muscles, must do all the work of breathing. Even when these muscles are compromised during exercise or shortness of breath, the diaphragm is a stabilizing force and helps move the chest.

If the diaphragm is too weak to stabilize the base of the chest cavity, the movement of the chest can pull the abdominal organs toward the chest during inhalation and away from the chest during exhalation.

Paradoxical breathing with weakness or paralysis of the diaphragm is described as a "rocking" between the chest wall and the abdominal wall.

As the rib cage expands, the abdominal organs move upward and presumably behind the breastbone, causing the abdominal wall to contract. When the rib cage contracts for exhalation, the organs are pushed back and the abdominal wall expands.

Paradoxical breathing due to a weak or paralyzed diaphragm often worsens while lying on your back (supine) and seems to disappear when you stand up .

Respiratory disorder

As noted above, if you have severe shortness of breath for long enough, fatigue in the intercostal muscles or diaphragm can lead to swing-type breathing. This is probably the most common cause of paradoxical breathing in both adults and children.

Respiratory failure is defined as fatigue from shortness of breath, also known as shortness of breath, which results in an inability to compensate. Respiratory failure can continue to get worse without treatment.

As the condition worsens, paradoxical breathing presents as one of many signs of increased work of breathing and decreased respiratory efficiency.


Paradoxical breathing can usually be visually detected and recognized by its opposite characteristic to normal breathing. You can see the chest / abdomen moving inward or into the body when inhaling and outward or away from the body when exhaling.

A doctor can perform X-rays, ultrasounds, other imaging tests, and blood tests to diagnose an underlying condition. They will want to see how much oxygen is entering your lungs, as paradoxical breathing indicates a decrease in the amount of air that can pass through the airways.

When these symptoms are found, it is extremely important to obtain medical attention so that the correct diagnosis can be made and the underlying disease can be cured.

Watch out

For a heavy chest or weakened diaphragm, treatment consists of stabilizing the paradoxical movement so that the chest can expand and contract as fully as possible. Stopping the movement of the unstable segment or abdominal wall helps the rib cage and lungs move air more efficiently.

The most important treatment for all cases of paradoxical breathing is to address the underlying cause, which is done only in the emergency department. This may include wearing an oxygen mask, repairing damage to your chest, and / or restoring a clear airway so you can breathe normally .

Get the word of drug information

Paradoxical breathing, for whatever reason, is unusual enough that many caregivers can pursue long careers, even in a medical emergency, and never have to deal with it. However, this is such an important sign that all ER doctors and paramedics learn to look for it.

If you have experienced a traumatic event that could have resulted in a chest impact, call 911.

If you notice a fluctuating paradoxical breathing movement combined with a feeling of shortness of breath even without obvious trauma, go to the emergency room. Diaphragm weakness or paralysis is treatable if caught early.

Frequently asked questions

  • Paradoxical breathing can make someone feel like they can't catch their breath. Other symptoms may include increased heart rate; neck, shoulder or chest pain (note: always seek medical attention for chest pain) ; involuntary breathing; soft spot; dizziness; and difficulty speaking.

  • Yes, there is a technique called diaphragmatic breathing that can help you strengthen your diaphragm. This technique involves lying on your back with your knees bent, placing one hand on your chest and the other under your rib cage, and slowly inhaling through your nose. The abdomen should move outward while the other arm remains immobile, and then exhale through pursed lips with tight abdominal muscles.

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