Respiratory failure is a condition in which your lungs have a hard time loading your blood with oxygen or removing carbon dioxide.
"Respiratory failure represents the respiratory system's inability to perform gas exchange," explains Aaron Waxman, MD, director of the Pulmonary Vascular Disease Program at Brigham and Women's Hospital in Boston, MA. "Gas exchange is the transit of oxygen into the bloodstream, and carbon dioxide out." It can leave you with low oxygen, high carbon dioxide, or both.
Types of Respiratory Failure
Hypoxemic respiratory failure
If you aren't getting enough oxygen into your blood, your doctor will call this hypoxemic or type 1 respiratory failure. A heart or lung illness is most likely to cause this type of respiratory failure.
Hypercapnic respiratory failure
If you have too much carbon dioxide, it's called hypercapnic, hypercarbic, or type 2 respiratory failure. When your body can't remove carbon dioxide, your blood cells fail to carry oxygen. Heart, lung, muscle, and brain and spinal cord conditions often cause this type of respiratory failure. Some medicines can also trigger it.
Perioperative respiratory failure
This form of respiratory failure happens during surgery when anesthesia stops you from breathing the right way. Your lungs' air sacs may collapse and stop oxygen from entering your blood.
Shock-related respiratory failure
When you go into shock, it can cause health problems that lead to respiratory failure, including low blood pressure and fluid in your lungs.
Acute respiratory failure
Acute respiratory failure comes on quickly, and it's an emergency. "Acute respiratory failure can affect anyone who suffers an acute injury or process that may affect the lungs, heart, or any part of the system that delivers oxygen to the tissues," Waxman says.
Chronic respiratory failure
Respiratory failure can also be chronic, a long-term problem that will need regular care. Chronic respiratory failure happens over time. A worsening health condition, such as one that affects your heart, lungs, brain, spinal cord, or nerves, can raise your chances of getting this type.
What Causes Respiratory Failure?
Breathing may seem like a simple act, but there are a lot of moving parts. A problem with any one of them can lead to respiratory failure, including:
- An injury to your chest or ribs
- A drug or alcohol overdose, which can harm your brain and breathing
- Lung damage from breathing in fumes or smoke
- Lung disease or infection, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, or pneumonia
- Muscle and nerve damage from conditions such as amyotrophic lateral sclerosis (ALS), spinal cord injuries, and stroke
- Scoliosis or other spine problems, which can affect the bones and muscles involved in breathing
- Blocked blood flow to your lung, such as from a blood clot
Acute respiratory failure is more common with an injury to your brain, chest, or lungs. Things such as choking, drowning, or getting hit in the chest could all do it. A sudden, serious illness that affects breathing, such as acute respiratory distress syndrome (ARDS), can also bring it on.
Risk Factors for Respiratory Failure
You might have a higher risk of respiratory failure if you:
- Have long-term respiratory problems such as COPD or asthma
- Smoke
- Drink a lot of alcohol
- Have a family history of respiratory problems
What Are the Symptoms?
Your symptoms will depend on the cause and whether you have low oxygen, high carbon dioxide, or both. Some things you may notice are:
- A bluish color to your fingernails, lips, and skin
- Feeling that you just can't take in enough air
- Confusion
- Heartbeat that's off
- Rapid breathing or extremely slow breathing
- Shortness of breath
- Sleepiness or passing out
Signs of death from respiratory failure
It's an emergency if you have breathing problems, confusion, or if your lips or skin turn blue. Call 911 and go to the hospital right away.
How Is Respiratory Failure Diagnosed?
Your doctor will start with a physical exam and ask questions about your health. You'll then get one or both of these tests:
Pulse oximetry. Your doctor puts a small device on your finger or ear to measure your oxygen level.
Arterial blood gas test. This basic blood test measures your levels of oxygen and carbon dioxide.
You may need more tests to look for the cause. That might include things such as a chest X-ray or an EKG, which measures electrical signals in your heart.
Respiratory failure vs. arrest
Respiratory failure is when there's not enough oxygen or too much carbon dioxide in your body, and respiratory arrest is when you stop breathing and don't get enough oxygen.
How Is Respiratory Failure Treated?
Your treatment might include:
Oxygen therapy. You breathe in oxygen, through either a mask or a thin tube with two prongs that sit just inside your nose. You can get a portable oxygen tank so you can still go out and about with it.
Ventilator. You might need one of these breathing machines if oxygen therapy isn't enough or if you can't breathe on your own. They blow air into your lungs to help you get the oxygen you need without having to work so hard for it. They also help lower carbon dioxide levels.
There are a few types. With smaller, simpler ones, you wear a mask over your nose or mouth. A CPAP machine, used for sleep apnea, is one example.
For a more severe problem, you might need a breathing tube that goes down your throat.
Tracheostomy. This is surgery in which your doctor makes an opening in your neck and windpipe to put in a small tube. It's called a trach tube and can make breathing easier. You may also get this if you need a ventilator for more than a week or two. The ventilator connects directly to the trach tube.
Treating the cause. You might need care for the condition that caused your respiratory failure, too. That could mean things such as:
- Antibiotics for pneumonia
- Drugs to break up blood clots
- Inhaled medicines to open the airways
- Chest tube to drain blood or extra air in cases of injury
Your treatment will depend on the cause and whether your respiratory failure is chronic or acute. Acute and chronic cases aren't treated the same way, but the ideas are similar:
Acute. You'll go to an ER, but if your treatment there doesn't solve the problem, you may need to stay overnight in the hospital. For severe symptoms, you may need to go to the intensive care unit (ICU). You may get oxygen therapy. And you may need a ventilator until you can breathe on your own. You'll also get medicine and fluids to ease your symptoms and treat the cause of your respiratory failure.
Chronic. You'll get ongoing care in your home, which typically includes medication you take every day — either inhaled medicine or drugs you take by mouth. In severe cases, you might need oxygen therapy.
Because respiratory failure can make it harder for you to sleep, you may also need extra help at night. That could mean one of the smaller ventilators, such as a CPAP machine, to get more air into your lungs. You may also need a special bed that rocks back and forth to help you breathe better. For more serious cases, you'll need a ventilator.
Can Respiratory Failure Be Prevented?
You may not be able to stop respiratory failure from happening, but you can lower your chances by controlling heart, lung, brain, spinal cord, or nerve conditions.
Respiratory Failure Prognosis
If you have acute respiratory failure, treatment right away can help get you back to your normal activities. With chronic respiratory failure, it's important to follow your doctor's advice about ongoing care. Know what your symptoms mean and when you might need to call your doctor.
Respiratory failure is serious, but many things can affect your outcome, including what's causing your condition.
Takeaways
Respiratory failure happens when your lungs can't bring in enough oxygen or can't remove enough carbon dioxide, which can make you feel short of breath, confused, or even cause you to pass out. There are different types depending on whether oxygen is too low, carbon dioxide is too high, or both. It can come on suddenly (acute) or form over time (chronic), and causes range from lung diseases and chest injuries to brain, nerve, or muscle problems. Treatment depends on the type and cause and may include oxygen therapy, ventilators, medication, or surgery, such as a tracheostomy.
Respiratory Failure FAQs
How long can you last with respiratory failure?
This depends on the type you have. Acute respiratory failure is life-threatening and requires a trip to the hospital right away. One study found that around 40% of people with acute respiratory distress lose their lives.
You can manage chronic respiratory failure with medication and oxygen therapy if needed. Researchers tracked people with chronic respiratory failure for over 4 ½ years to see what factors affected how long they lived. Nearly half lost their lives during the study. Researchers linked age, how well your lungs work, and other factors to survival.
Is tracheal stenosis acute hypoxic respiratory failure?
Hypoxic respiratory failure happens when you don't have enough oxygen in your blood, and inflammation or scarring on your windpipe (trachea) causes tracheal stenosis. The condition narrows your trachea, making it harder for you to breathe.
Can coronary artery disease cause respiratory failure?
Yes. Diseases that affect your heart are a risk factor for respiratory failure.
