The purpose of this exploratory study was to identify behaviors that may signify respiratory distress across cognitive states in response to an asphyxial threat. Patients undergoing a ventilator weaning trial were assessed and observed at baseline and during weaning with a capnograph/oximeter and video camera. Cognitive state was categorized at baseline, and an emotion report was elicited after the trial. Pulmonary stress and fear behaviors were similar across cognitive states. Hypercarbia predicted activation of fear behaviors. Gender differences characterized emotion reporting. An asphyxial threat may induce an innate array of behaviors that cannot be volitionally controlled and that may have the same appearance across cognitive states. Recognizing respiratory distress behaviors may improve nursing care of patients who are cognitively impaired.