Definition

Respiratory failure is when the lungs struggle to supply oxygen to the blood and have difficulty removing carbon dioxide from the blood. This condition leads to decreased oxygen levels in the body while carbon dioxide levels increase. Low oxygen levels in the body disrupt the function of the body's organs.

When there is insufficient oxygen in the blood, it is called hypoxemia or type 1 respiratory failure. Meanwhile, if there is too much carbon dioxide in the blood, it is referred to as hypercapnia, hypercarbia, or type 2 respiratory failure.

Acute respiratory failure occurs rapidly and is emergent. However, respiratory failure can also become chronic, lasting long-term, and requires exceptional management.

Causes

Although breathing may seem simple, it involves many parts of the body. Problems with any of these body parts can lead to respiratory failure, including:

• Chest or rib cage injuries
• Drug or alcohol overdose, which can disrupt the brain's control of breathing
• Lung damage from inhaling smoke or pollution
• Lung diseases or infections such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, or pneumonia
• Muscle and nerve damage affecting breathing due to certain diseases such as amyotrophic lateral sclerosis (ALS), spinal cord injury, or stroke
• Scoliosis or other spinal problems, which can affect the bones and muscles involved in breathing
• Blockage of blood flow to the lungs, such as from a blood clot

Acute respiratory failure more often occurs due to brain, chest, or lung injuries. Conditions such as choking, drowning, or being shot in the chest area can cause acute respiratory failure. Serious respiratory diseases like acute respiratory distress syndrome (ARDS) can also lead to acute respiratory failure rapidly.

Risk factor

You are at a higher risk of experiencing respiratory failure if you:

• Have long-term respiratory diseases such as COPD or asthma
• Smoke
• Abuse alcohol
• Have a family history of respiratory problems

Symptoms

Symptoms of respiratory failure vary depending on the cause and whether you are experiencing hypoxemia or hypercapnia. Some signs and symptoms of respiratory failure to watch out for include:

• Bluish coloration of nails, lips, and skin
• Feeling unable to take in enough air
• Confusion
• Loss of heartbeats
• Breathing rapidly or very slowly
• Gasping for breath
• Feeling drowsy or fainting

Diagnosis

Doctors will begin diagnosing by asking about your symptoms and medical history, then conducting a physical examination. After that, the doctor may perform or recommend several tests, including:

• Pulse oximetry. A small device is placed on the finger to measure oxygen levels in the blood.
• Arterial blood gas test. This test measures oxygen and carbon dioxide levels in the body.
• Chest X-ray, to look for abnormalities in the chest cavity.
• Electrocardiogram or EKG, to measure heart electrical signals.

Management

Management of respiratory failure includes:

Oxygen therapy

Oxygen supplementation can be provided through a mask or nasal cannula. Portable oxygen tanks are available for easier transport if needed.

Ventilator

A mechanical ventilator or breathing machine is required if oxygen therapy is insufficient. This device delivers oxygen to the lungs so the body can receive the necessary oxygen easily. Ventilators also help reduce carbon dioxide levels.

There are several types of ventilators. The simplest one is connected with an oxygen mask covering the nose and mouth. One example of a simple breathing assist device is CPAP, which manages sleep apnea or temporary breathing cessation during sleep.

In more severe cases, a breathing tube inserted directly into the throat and connected to a ventilator is required.

Tracheostomy

Tracheostomy is a surgical procedure to create a hole in the neck to insert a small tube into the windpipe as an airway passage. This tube facilitates the patient's breathing. A tracheostomy tube is also necessary if the patient requires a ventilator for more than 1 or 2 weeks. The tracheostomy tube is directly connected to the ventilator.

Treating the underlying cause

Here are some treatments for the causes of respiratory failure:

• Antibiotics to treat pneumonia or lung infections
• Blood clot-dissolving medications
• Inhaled medications to open airways
• Chest tube to drain blood or air buildup in the lungs in case of injury

Treatment for respiratory failure depends on its cause and whether it is chronic or acute. Respiratory failure is acute if it occurs suddenly and recently. Meanwhile, it is chronic if it has been ongoing for a long period.

In acute respiratory failure, patients should be promptly treated in the emergency department (ED). However, if ED treatment is not successful, patients may need hospitalization. Treatment in the intensive care unit (ICU) may be necessary for severe cases. Patients will receive oxygen therapy, require a ventilator until they can breathe on their own, and receive medications and fluids to alleviate symptoms and treat the underlying cause of respiratory failure.

In chronic respiratory failure, patients will receive ongoing care at home, usually including routine medications, either inhalers or orally. In severe cases, patients may require oxygen therapy.

Because respiratory failure can disrupt sleep, patients also need more assistance at night, such as using a small ventilator to deliver more oxygen to the lungs. Or patients may use special rocking beds to help them breathe better. In more serious cases, patients require a ventilator.

Complications

Often, there is no cure for chronic respiratory failure. However, its symptoms can be managed with treatment. If you have long-term lung diseases such as COPD or emphysema, you may need continuous respiratory support. The progression of your condition depends on the cause of respiratory failure, your overall health, and how quickly you receive treatment.

Complications of respiratory failure can be caused by disturbances in blood gases or by side effects of treatment. Some complications of respiratory failure based on the affected organs include:

• Lung complications, such as pulmonary embolism (blockage of lung blood vessels), scar tissue formation in the lungs, pneumothorax (air buildup in the lung lining), and dependence on ventilators
• Heart complications, such as arrhythmia (irregular heartbeat), heart failure, cardiac arrest, and acute myocardial infarction (heart attack)
• Neurological complications such as long-term oxygen deficiency in the brain can cause brain cell damage to death
• Kidney complications include acute kidney failure due to oxygen deficiency or side effects of certain medications
• Digestive complications include stress ulcers, gastrointestinal motility disorders, and bleeding
• Nutritional complications include malnutrition, hypoglycemic diarrhea, and electrolyte disorders
• Infections include sepsis, a widespread infection that spreads through the bloodstream. This complication is the most common cause of death in acute respiratory failure
• Death from multiorgan failure

Prevention

If you have other conditions that increase the risk of respiratory failure, it is crucial to follow the management plan provided by your doctor. Some things you can do to keep your lungs healthy include quitting or avoiding smoking altogether, reducing alcohol consumption, and avoiding illicit drugs.

Your doctor will also recommend a healthy lifestyle, such as being more active, following a diet suitable for your body condition and underlying diseases, achieving an ideal body weight, managing stress, and getting enough sleep. A healthy lifestyle will reduce your risk of experiencing respiratory failure.

When to see a doctor? 

If you experience the signs and symptoms of respiratory failure mentioned above, immediately call the emergency phone number or seek help at the emergency department.