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Emergency Medical Minute


Apr 24, 2019

Author: Gretchen Hinson, MD

Educational Pearls:

  • Breath stacking occurs when a patient is unable to expire fully before another inspiration
  • In intubated/ventilated patients, this is because adequate time has not passed before exhalation
  • Asthmatics are susceptible due to the prolonged expiratory phase
  • Complications can include reduction in cardiac preload and cardiovascular collapse
  • Pursed-lip breathing can help in the spontaneously breathing patient
  • Intubation may be required when patients present with status asthmaticus and breath stacking


Phipps P, Garrard CS. The pulmonary physician in critical care . 12: Acute severe asthma in the intensive care unit. Thorax. 2003 Jan;58(1):81-8. Review. PubMed PMID: 12511728; PubMed Central PMCID: PMC1746457.

Pohlman MC, McCallister KE, Schweickert WD, Pohlman AS, Nigos CP, Krishnan JA, Charbeneau JT, Gehlbach BK, Kress JP, Hall JB. Excessive tidal volume from breath stacking during lung-protective ventilation for acute lung injury. Crit Care Med. 2008 Nov;36(11):3019-23. doi: 10.1097/CCM.0b013e31818b308b. PubMed PMID: 18824913.

Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD