Respiratory failure occurs when the lungs cannot exchange gases effectively. As a result, the body may not receive enough oxygen and/or may not be able to remove carbon dioxide properly.
Respiratory failure can cause severe shortness of breath and extreme fatigue. It may result from conditions affecting the lungs, breathing muscles, or nervous system, including COPD, emphysema, brain tumors, or heart failure.
Treatment for respiratory failure is usually managed by a pulmonologist or general practitioner and should begin as soon as possible in a hospital when symptoms develop suddenly. In chronic cases, treatment is tailored to the underlying cause and the person's specific needs.
Symptoms of respiratory failure
The main symptoms of respiratory failure are:
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Shortness of breath, even at rest;
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Rapid breathing and wheezing;
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Bluish skin, lips, or nails;
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Cough with phlegm, sometimes with blood;
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Chest pain and irregular heartbeat;
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Extreme fatigue;
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A burning sensation in the stomach;
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Loss of appetite and weight loss;
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Swelling in the abdomen and legs.
Respiratory failure may also cause excessive sweating, pale skin, headache, and blurred vision.
In severe cases, respiratory failure can lead to confusion, agitation, behavioral changes, loss of consciousness, and abnormal heart rhythms.
How a diagnosis is confirmed
Respiratory failure is diagnosed by a pulmonologist or general practitioner based on the person's medical history, symptoms, and vital signs. This usually includes pulse oximetry, which measures the oxygen level in the blood.
The doctor may also order blood tests, such as an arterial blood gas test, which measures oxygen and carbon dioxide levels in the blood and helps assess respiratory function.
When there is no obvious cause of respiratory failure, imaging tests such as a chest X-ray or CT scan may be ordered to identify problems affecting the lungs.
Types of respiratory failure
The main types of respiratory failure are:
1. Acute respiratory failure
Acute respiratory failure develops suddenly, usually because of airway obstruction, motor vehicle accidents, drug overdose, or stroke. It is generally a serious condition that requires immediate hospital care.
2. Chronic respiratory failure
Chronic respiratory failure develops gradually as a result of chronic conditions such as COPD. It can make everyday activities, such as climbing stairs, difficult because of shortness of breath.
Chronic respiratory failure can often be controlled, although acute episodes may still occur.
Possible causes
Respiratory failure can be caused by any disease or condition that directly or indirectly affects the lungs. The main causes include:
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Respiratory conditions, such as COPD, asthma, pneumonia, bronchitis, pulmonary embolism, emphysema, pulmonary fibrosis, and COVID-19;
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Lung problems caused by fluid buildup, scarring, blocked blood flow, or insufficient airflow;
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Neurological conditions, such as stroke, amyotrophic lateral sclerosis, muscular dystrophy, Guillain-Barré syndrome, encephalitis, and brain tumors;
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Scoliosis, trauma, or fractures that interfere with breathing;
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Heart conditions, such as heart failure, heart attack, congenital heart disease, shock, sepsis, and blood loss;
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Infections, such as botulism, polio, and systemic infections.
External factors may also cause respiratory failure, including drug overdose, opioid or benzodiazepine use, and poisoning from alcohol or chemicals.
Treatment options
Treatment for respiratory failure is provided by a pulmonologist or general practitioner and depends on whether the condition is acute or chronic. Acute respiratory failure should be treated as quickly as possible in a hospital.
Chronic respiratory failure may sometimes be managed at home with treatments such as oxygen therapy delivered through a mask or nasal cannula and noninvasive ventilation using devices such as CPAP.
In some situations, medications may be needed to help loosen and thin thick respiratory secretions. Inhaled acetylcysteine is one FDA-approved mucolytic option that may be used for this purpose, while intravenous fluids may also be given when medically indicated.
A tracheostomy may also be recommended. This surgical procedure creates an opening that helps air move into the airway and may be needed in certain conditions affecting the mouth or throat, including tumors or cancer.
Respiratory therapy may also help improve respiratory muscle function and relieve symptoms. In certain cases, prone positioning, in which the person lies on the stomach, may be used to improve lung expansion and blood oxygenation.