What is respiratory failure

Respiratory failure is a condition in which your blood doesn’t have enough oxygen from your lungs or has too much carbon dioxide (a waste gas). Sometimes you can have both problems —a low oxygen level and a high carbon dioxide level in the blood—can occur at the same time.

• When respiratory failure causes a low level of oxygen in the blood, it’s called hypoxemic respiratory failure.
• When respiratory failure causes a high level of carbon dioxide in the blood, it’s called hypercapnic respiratory failure.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide (a waste gas) from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your body’s organs.

Diseases and conditions that affect your breathing can cause respiratory failure. Examples include COPD (chronic obstructive pulmonary disease) and spinal cord injuries. COPD prevents enough air from flowing in and out of the airways. Spinal cord injuries can damage the nerves that control breathing.

To understand respiratory failure, it helps to understand how the lungs work. When you breathe, air passes through your nose and mouth into your windpipe. The air then travels to your lungs’ air sacs. These sacs are called alveoli.

Small blood vessels called capillaries run through the walls of the air sacs. When air reaches the air sacs, the oxygen in the air passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the air sacs. This process is called gas exchange.

In respiratory failure, gas exchange is impaired.

Respiratory failure can be acute (short term) or chronic (ongoing). Acute respiratory failure can develop quickly and may require emergency treatment. Chronic respiratory failure develops more slowly and lasts longer.

Signs and symptoms of respiratory failure may include shortness of breath, rapid breathing, and air hunger (feeling like you can’t breathe in enough air). In severe cases, signs and symptoms may include a bluish color on your skin, lips, and fingernails; confusion; and sleepiness.

One of the main goals of treating respiratory failure is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the underlying cause of the condition.

Acute respiratory failure usually is treated in an intensive care unit. Chronic respiratory failure can be treated at home or at a long-term care center.

If you have respiratory failure, you may receive oxygen therapy. Extra oxygen is given through a nasal cannula (two small plastic tubes, or prongs, that are placed in both nostrils) or through a mask that fits over your nose and mouth. Oxygen also can be given through a tracheostomy. This is a surgically made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy or trach tube, is placed in the hole to help you breathe.

Respiratory system

Figure 1 below is your respiratory system, which shows how you breathe. Breathing is the process that brings oxygen in the air into your lungs and moves oxygen and through your body. Your lungs remove the oxygen and pass it through our bloodstream, where it’s carried off to the tissues and organs that allow us to walk, talk, and move. Your lungs also take carbon dioxide from our blood and release it into the air when you breathe out.

The SINUSES are hollow spaces in the bones of your head. Small openings connect them to the nasal cavity. The sinuses help to regulate the temperature and humidity of the air your breathe in, as well as to lighten the bone structure of the head and to give tone to your voice.

The NASAL CAVITY (nose) is the best entrance for outside air into your respiratory system. The hairs that line the inside wall are part of the air-cleansing system.

Air can also enters through your ORAL CAVITY (mouth), especially if you have a mouth-breathing habit or your nasal passages may be temporarily blocked.

The ADENOIDS are overgrown lymph tissues at the top of the throat. When your adenoids interfere with your breathing, they are sometimes removed. The lymph system, consisting of nodes (knots of cells) and connecting vessels, carries fluid throughout the body. This system helps your body resist infection by filtering out foreign matter, including germs, and producing cells (lymphocytes) to fight them.

The TONSILS are lymph nodes in the wall of your pharynx. Tonsils are not an important part of the germ-fighting system of the body. If they become infected, they are sometimes removed.

The PHARYNX (throat) collects incoming air from your nose and passes it downward to your trachea (windpipe).

The EPIGLOTTIS is a flap of tissue that guards the entrance to your trachea. It closes when anything is swallowed that should go into the esophagus and stomach.

The LARYNX (voice box) contains your vocal cords. When moving air is breathed in and out, it creates voice sounds.

The ESOPHAGUS is the passage leading from your mouth and throat to your stomach.

The TRACHEA (windpipe) is the passage leading from your pharynx to the lungs.

The RIBS are bones supporting and protecting your chest cavity. They move a small amount and help the lungs to expand and contract.

The trachea divides into the two main BRONCHI (tubes), one for each lung. The bronchi, in turn, subdivide further into bronchioles.

The RIGHT LUNG is divided into three LOBES, or sections.

The left lung is divided into two LOBES.

The PLEURA are the two membranes that surround each lobe of your lungs and separate the lungs from your chest wall.

The bronchial tubes are lined with CILIA (like very small hairs) that have a wave-like motion. This motion carries MUCUS (sticky phlegm or liquid) upward and out into the throat, where it is either coughed up or swallowed. The mucus catches and holds much of the dust, germs, and other unwanted matter that has invaded your lungs. Your lungs get rid of the mucus through coughing.

The DIAPHRAGM is the strong wall of muscle that separates your chest cavity from your abdominal cavity. By moving downward, it creates suction to draw in air and expand the lungs.

The smallest section of the bronchi are called BRONCHIOLES, at the end of which are the alveoli (plural of alveolus).

The ALVEOLI are the very small air sacs that are the destination of air that you breathe in. The CAPILLARIES are blood vessels that are imbedded in the walls of the alveoli. Blood passes through the capillaries, brought to them by the PULMONARY ARTERY and taken away by the PULMONARY VEIN. While in the capillaries, the blood moves carbon dioxide into the alveoli and takes up oxygen from the air in the alveoli.

Figure 1. Respiratory system

Respiratory failure causes

Diseases and conditions that affect your breathing can cause respiratory failure. These diseases and conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These diseases and conditions include:

• Lung diseases such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, pulmonary embolism and ARDS (acute respiratory distress syndrome). These diseases and conditions can affect the flow of air and blood into and out of your lungs. ARDS (acute respiratory distress syndrome) and pneumonia affect gas exchange in the air sacs.
• Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
• Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
• Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
• Drug or alcohol overdose. An overdose affects the area of the brain that controls breathing. During an overdose, breathing becomes slow and shallow.
• Inhalation lung injuries, such as from inhaling smoke (from fires) or harmful fumes can injure your lungs

When breathing is impaired, your lungs can’t easily move oxygen into your blood and remove carbon dioxide from your blood (gas exchange). This can cause a low oxygen level or high carbon dioxide level, or both, in your blood.

Risk factors for respiratory failure

People who have diseases or conditions that affect the muscles, nerves, bones, or tissues that support breathing are at risk for respiratory failure. People who have lung diseases or conditions also are at risk for respiratory failure.

Respiratory failure signs and symptoms

The signs and symptoms of respiratory failure depend on its underlying cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath (dyspnea) and air hunger (the feeling that you can’t breathe in enough air). Your skin, lips, and fingernails may also have a bluish color (cyanosis). A high carbon dioxide level can cause rapid breathing (tachypnea) and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

Respiratory failure diagnosis

Your doctor will diagnose respiratory failure based on:

• Your medical history: Your doctor will ask whether you might have or have recently had diseases or conditions that could lead to respiratory failure. Examples include disorders that affect the muscles, nerves, bones, or tissues that support breathing. Lung diseases and conditions also can cause respiratory failure.
• A physical exam, which often includes:
  • Listening to your lungs to check for abnormal sounds
  • Listening to your heart to check for arrhythmia
  • Looking for a bluish color on your skin, lips, and fingernails
• Diagnostic tests, such as:
  • Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
  • Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

A low level of oxygen or a high level of carbon dioxide in the blood (or both) is a possible sign of respiratory failure.

Your doctor may recommend other tests, such as a chest x ray, to help find the underlying cause of respiratory failure. A chest x ray is a painless test that takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels.

If your doctor thinks that you have an arrhythmia as a result of respiratory failure, he or she may recommend an EKG (electrocardiogram). An EKG is a simple, painless test that detects and records the heart’s electrical activity.

Respiratory failure treatment

Treatment for respiratory failure depends on:

• Whether it is acute (short-term) or chronic (ongoing) respiratory failure
• How severe is your respiratory failure
• What is causing your respiratory failure

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include:

• Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
• Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe. Oxygen also can be given through a tracheostomy. If the oxygen level in your blood doesn’t increase, or if you’re still having trouble breathing, your doctor may recommend a ventilator. A ventilator is a machine that supports breathing. It blows air—or air with increased amounts of oxygen—into your airways and then your lungs.
• Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs. Your doctor will adjust the ventilator as needed. This will help your lungs get the right amount of oxygen. It also can prevent the machine’s pressure from injuring your lungs. You’ll use the ventilator until you can breathe on your own.
• Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. You wear a mask or other device that fits over your nose or your nose and mouth. A tube connects the mask to a machine, which blows air into the tube. CPAP (continuous positive airway pressure) is one type of noninvasive positive pressure ventilation (NPPV). Another treatment is a special bed that rocks back and forth, to help you breathe in and out. When your head rocks down, the organs in your abdomen and your diaphragm (the main muscle used for breathing) slide up, helping you exhale. When your head rocks up, the organs in your abdomen and your diaphragm slide down, helping you inhale. These methods are very useful for people who have chronic respiratory failure.
• Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition. Your doctor will make sure you get the right amount of fluids. Too much fluid can fill the lungs and make it hard for you to get the oxygen you need. Not enough fluid can limit the flow of oxygen-rich blood to the body’s organs.
• Medicines for discomfort
• Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.

Respiratory failure prognosis

The outlook for respiratory failure depends on the severity of its underlying cause, how quickly treatment begins, and your overall health.

People who have severe lung diseases may need long-term or ongoing breathing support, such as oxygen therapy or the help of a ventilator. A ventilator is a machine that supports breathing. It blows air—or air with increased amounts of oxygen—into your airways and then your lungs.

Living with respiratory failure

One of the main goals of treating respiratory failure is to treat the underlying cause of the condition. However, sometimes it’s hard to cure or control the underlying cause. Thus, respiratory failure may last for weeks or even years. This is called chronic respiratory failure.

Oxygen therapy and other treatments can help you breathe easier. However, your oxygen and carbon dioxide levels still may not be normal. Thus, you may have one or more of the following symptoms:

• Shortness of breath
• Rapid breathing
• Tiredness and confusion

These symptoms may go away within a few weeks or last longer. Talk with your doctor about how to deal with these symptoms, and read the tips below.

Ongoing care

If you have respiratory failure, see your doctor for ongoing medical care. Your doctor may refer you to pulmonary rehabilitation (rehab).

Rehab can involve exercise training, education, and counseling. Your rehab team might include doctors, nurses, and other specialists. They’ll work with you to create a program that meets your needs.

If you smoke, quit. Talk to your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

If you’re on oxygen therapy, don’t smoke. Oxygen isn’t explosive, but it can worsen a fire. In the presence of oxygen, a small fire can quickly get out of control. Also, the cylinder that compressed oxygen gas comes in can explode when exposed to heat.

Emotional issues and support

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to living with respiratory failure. You can see how other people who have the same symptoms have coped with them. Talk to your doctor about local support groups or check with an area medical center.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.

Prepare for emergencies

If you have chronic respiratory failure, knowing when and where to seek help for your symptoms is important. You should seek emergency care if you have severe symptoms, such as trouble catching your breath or talking.

Call your doctor if you notice that your symptoms are worsening or if you have new signs and symptoms. Your doctor may change or adjust your treatments to relieve and treat symptoms.

Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor’s office and hospital and a list of all the medicines you’re taking.