Respiratory Failure

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Introduction

What is respiratory failure?

Respiratory failure is the inability of the respiratory system to adequately supply fresh oxygen or remove carbon dioxide, resulting in low blood oxygen or high blood carbon dioxide levels, respectively. Multiple conditions can cause one or both of these problems. Acute or sudden respiratory failure can happen as the result of trauma, injury, drug or alcohol overdose, or inhalation of carbon monoxide. Chronic, or long-term, respiratory failure is commonly caused by chronic obstructive pulmonary disease (COPD), neuromuscular disease, or even morbid obesity.

The signs and symptoms of respiratory failure differ depending on the severity and underlying cause. Acute respiratory failure occurs rapidly and can resolve with treatment. Chronic respiratory failure, on the other hand, is a progressive disease, which typically worsens over time. Symptoms of respiratory failure include difficulty breathing, cyanosis (blue or purple coloration of the skin), and lethargy. Treatment depends on the severity of the disease and may include oxygen support, bronchodilators, and ventilatory support.

Respiratory failure can be a serious or life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms, such as severe difficulty breathing; severe sharp chest pain; bluish coloration of the lips or fingernails; a change in level of consciousness or alertness, such as passing out or unresponsiveness; and rapid heart rate.

Seek prompt medical care if you are being treated for respiratory failure but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of respiratory failure?

Respiratory failure causes insufficient oxygenation or ventilation and can cause a number of symptoms, which can be severe.

Common symptoms of respiratory failure

Respiratory failure is accompanied by a number of symptoms including:

  • Bluish coloration of the lips or fingernails

  • Confusion or loss of consciousness

  • Fainting or change in level of consciousness or lethargy

  • Fatigue

  • Irregular heart rate (arrhythmia)

  • Rapid breathing (tachypnea) or shortness of breath

Serious symptoms that might indicate a life-threatening condition

In some cases, respiratory failure can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bluish coloration of the lips or fingernails

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Rapid heart rate (tachycardia)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

Causes

What causes respiratory failure?

Respiratory failure is the inability of the respiratory system to supply oxygen or remove carbon dioxide, resulting in low blood oxygen or high blood carbon dioxide levels. Multiple conditions can cause one or both of these problems. Respiratory failure can transpire quickly as the result of trauma, injury, drug or alcohol overdose, or inhalation of carbon monoxide. Chronic, or long-term, respiratory failure is commonly caused by chronic obstructive pulmonary disease (COPD), neuromuscular disease, or even morbid obesity.

Causes of acute respiratory failure

A number of conditions may cause acute respiratory failure, many of which are life-threatening or serious conditions. Examples include:

Causes of chronic respiratory failure

A number of conditions may cause chronic respiratory failure, many of which are serious conditions. Examples include:

What are the risk factors for respiratory failure?

  • Aspiration of stomach contents
  • Combination of drug and alcohol use
  • Multiple blood transfusions
  • Severe obesity
  • Shock
  • Chronic obstructive pulmonary disease
Treatments

How is respiratory failure treated?

Treatment for respiratory failure begins with seeking medical care from your health care provider. The goals of treatment for respiratory failure are to increase oxygenation and improve ventilation. Treatment depends on the severity of the respiratory failure and the cause. Acute respiratory failure treatment will address the underlying cause and include ventilation and oxygenation as needed. Treatment for chronic respiratory failure may be administered at home. Exacerbation of chronic respiratory failure by infection may require hospitalization, and treatment may include oxygenation and ventilator support. Bronchodilators may improve airway patency.

Respiratory failure treatment options

Multiple options are available for the treatment of respiratory failure. Examples include:

  • Antibiotics for respiratory infections

  • Bilevel positive airway pressure (BiPAP)

  • Bronchodilators, including anticholinergics, such as tiotropium (Spiriva), or beta agonists, such as albuterol (Proventil)

  • Continuous positive airway pressure (CPAP)

  • Inhaled steroid medications to decrease inflammation

  • Lung transplant, in rare cases

  • Mechanical ventilation, if oxygen therapy if not sufficient to increase blood oxygen levels

  • Oxygen therapy to increase blood oxygen levels

  • Tracheostomy, a hole made in the front of the neck to help you breathe

What are the potential complications of respiratory failure?

Complications of untreated respiratory failure can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of respiratory failure include:

  • Heart failure
  • Myocardial infarction (heart attack)
  • Organ failure or dysfunction
  • Oxygen toxicity
  • Permanent lung damage
  • Pneumonia
  • Respiratory arrest
  • Shock
  • Stroke
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Respiratory acidosis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001154/.
  2. What is respiratory failure? National Heart, Lung, and Blood Institute Diseases and Conditions Index. http://www.nhlbi.nih.gov/health/dci/Diseases/rf/rf_whatis.html.
  3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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