Respiratory Failure: Causes, Symptoms, Diagnosis and Treatment

Respiratory failure is a condition in which the blood has too little oxygen, too much carbon dioxide, or both.

Breathing does two jobs. The lungs take in oxygen, which passes into the blood and on to organs such as the heart and brain, which need oxygen-rich blood to work. And they remove carbon dioxide from the blood so it can be breathed out — too much of it can harm the organs.

Causes

Anything that affects breathing — the muscles, nerves, bones or tissues that support it, or the lungs themselves:

• lung diseases such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, pulmonary embolism and COVID-19;
• conditions of the nerves and muscles that control breathing, such as ALS (amyotrophic lateral sclerosis), muscular dystrophy, spinal cord injuries and stroke;
• spine problems such as scoliosis, which can affect the bones and muscles used to breathe;
• damage to the tissues and ribs around the lungs, for example from a chest injury;
• drug or alcohol overdose;
• inhalation injuries, from smoke or harmful fumes.

Symptoms

They depend on the cause and on the oxygen and carbon dioxide levels:

• Low oxygen: shortness of breath and air hunger (feeling you can't get enough air); bluish skin, lips and fingernails.
• High carbon dioxide: rapid breathing and confusion.
• Some people become very sleepy or lose consciousness, or develop an arrhythmia (irregular heartbeat) — signs the brain and heart aren't getting enough oxygen.

Diagnosis

• Medical history.
• Physical exam: listening to the lungs for abnormal sounds and the heart for arrhythmia, and looking for bluish skin, lips and nails.
• Pulse oximetry: a small light sensor on the finger or ear measures blood oxygen.
• Arterial blood gas test: blood, usually from an artery in the wrist, is tested for oxygen and carbon dioxide.

Then the provider looks for the cause — often with a chest X-ray — and, if arrhythmia is suspected, an EKG (electrocardiogram), a simple, painless record of the heart's electrical activity.

Treatment

It depends on whether the failure is acute (short-term) or chronic (ongoing), how severe it is, and its cause. Acute respiratory failure can be a medical emergency needing an intensive care unit. Chronic respiratory failure can often be treated at home, or in a long-term care center if severe.

The goals: get oxygen to the lungs and organs, remove carbon dioxide, and treat the cause. Treatments may include:

• oxygen therapy, through a nasal cannula (two small tubes in the nostrils) or a mask;
• a tracheostomy — a surgical opening through the front of the neck into the windpipe, holding a breathing (trach) tube;
• a ventilator, a machine that blows air into the lungs and carries carbon dioxide out;
• other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep the airways open during sleep, or a special rocking bed that helps you breathe in and out;
• intravenous fluids, to improve blood flow and provide nutrition;
• medicines for discomfort;
• treatment of the cause, with medicines or procedures.

Living with it

Keep up ongoing care; your provider may suggest pulmonary rehabilitation. With chronic respiratory failure, know when and where to get help:

• get emergency care for severe symptoms, such as trouble catching your breath or talking;
• call your provider if symptoms worsen or new ones appear.

Living with respiratory failure can bring fear, anxiety, depression and stress; talk therapy, medicines and support groups can help.

Sources

Based on "Respiratory Failure," MedlinePlus, National Library of Medicine, drawing on the National Heart, Lung, and Blood Institute; a work of the United States government in the public domain.