Respiratory Failure

Respiratory failure is when your respiratory system isn’t working as it should. This means your body’s not getting enough oxygen or there’s too much carbon dioxide (CO2) in your blood.

When you breathe air in, it travels to small air sacs in your lungs (alveoli). There, blood in nearby blood vessels picks up oxygen to deliver to your tissues. Your blood also drops off carbon dioxide into your lungs so you can breathe it out.

If any part of this process doesn’t work, your body might not get enough oxygen, or CO2 can build up. It most often happens due to issues with your lungs, heart or brain. This can lead to respiratory failure.

Respiratory failure is a medical emergency. Call 911 or seek medical attention right away if you have symptoms of respiratory failure, like difficulty breathing, extreme fatigue, a racing heart and excessive sweating.

Types

Respiratory failure can come on suddenly (acute) or over time (chronic). Types include:

• Hypoxemic respiratory failure (type 1): This happens when you don’t have enough oxygen in your blood (hypoxemia). Heart and lung conditions are the most common causes. It’s also called hypoxic respiratory failure.
• Hypercapnic respiratory failure (type 2): This happens when you have too much CO2 in your blood (hypercapnia). If your body can’t get rid of CO2, there isn’t room for your blood cells to carry oxygen. Heart, lung, muscle and neurological (brain and spinal cord) conditions are the most common causes. Certain medications can cause it, too. It’s also called hypercarbic respiratory failure.
• Perioperative respiratory failure (type 3): This can happen due to surgery, like if anesthesia keeps you from breathing properly. Sometimes, air sacs in your lungs can collapse and keep oxygen from getting into your blood.
• Respiratory failure due to shock (type 4): Shock is a condition that causes low blood pressure, fluid in your lungs and other issues that can lead to respiratory failure. Sepsis, severe allergic reactions, heart issues and blood loss can cause shock.

Hypoxemic and hypercapnic respiratory failure are the most common types.

Symptoms of respiratory failure

Symptoms of respiratory failure depend on the cause. They can include:

• Shortness of breath or feeling like you can’t get enough air
• Rapid breathing
• Extreme tiredness
• Fast heart rate, racing heart or heart palpitations
• Spitting or coughing up blood or bloody mucus
• Excessive sweating
• Restlessness
• Pale skin
• Bluish or grayish skin, lips or nails (cyanosis)
• Headaches
• Blurred vision
• Agitation, confusion or being unable to think straight
• Behavioral changes or not acting like yourself

Respiratory failure causes

Respiratory failure happens when something keeps your body from getting oxygen into your blood or getting carbon dioxide out of your blood. This can be due to:

• Too little air flow or blood flow to your lungs
• Blockages, scarring or fluid in your lungs
• Inability to breathe properly or deeply enough, like if you have a condition that affects your lungs, the nerves or the muscles that you use to breathe
• Abnormalities in the way blood flows through your heart

Risk factors

Risk factors for respiratory failure include:

• Lung conditions and diseases, like COPD, pneumonia, cystic fibrosis, pulmonary edema, pulmonary embolism and pulmonary fibrosis
• Heart or blood flow conditions and diseases, like heart attack, congenital heart disease, heart failure and shock
• Conditions that affect the nerves and muscles that help you breathe, such as muscular dystrophy, amyotrophic lateral sclerosis (ALS), severe scoliosis and Guillain-Barré syndrome
• Chest, spinal cord or brain injuries (including stroke)
• Smoking or exposure to other lung irritants, like chemical fumes, dust and asbestos
• Surgery that requires sedation or anesthesia
• Drug use or excessive alcohol consumption

Newborn babies (especially premature infants) and adults over 65 are at higher risk for respiratory failure.

Complications

A lack of oxygen to your tissues can damage your organs. This can eventually lead to permanent lung scarring, heart issues and cognitive (thinking) issues or death.

How doctors diagnose respiratory failure

A provider diagnoses respiratory failure by testing the amount of oxygen and carbon dioxide in your blood. They’ll check your blood pressure and use a small device on your finger to check your oxygen levels. They’ll listen to your heart and lungs and examine you.

You might need additional tests, including:

• Arterial blood gas (ABG) test to measure the levels of oxygen and carbon dioxide in your blood
• Lung function tests to check how well your lungs work
• Imaging to get images of the inside of your body, like a chest X-ray or CT scan
• Electrocardiogram (EKG) to test how well your heart works

How is respiratory failure treated?

How providers treat respiratory failure depends on how severe it is and what’s causing it. Treatments focus on managing the underlying cause, giving you more oxygen or using a machine to breathe for you until you’re able to on your own again.

Treatments could include:

• Mechanical ventilation: A tube attached to a breathing machine goes into your airways to move air in and out of your lungs.
• Extracorporeal membrane oxygenation (ECMO): A bypass machine adds oxygen to your blood and removes carbon dioxide.
• Oxygen therapy: A machine delivers extra oxygen through a breathing mask or small tube (cannula). You may get oxygen at home or in the hospital.
• Fluids: A provider gives you fluids directly into a vein. This can improve blood flow, bringing more oxygen to your tissues.

Your provider may also treat you with other medications or procedures, depending on what’s causing respiratory failure.

Acute respiratory failure is an emergency and needs to be treated right away. Mild chronic respiratory failure can often be treated at home by managing the condition that’s causing it.

When should I see my healthcare provider?

You can lower your risk of chronic respiratory failure by managing ongoing heart, lung and neurological conditions. Talk to your healthcare provider if you have a chronic condition that puts you at risk for respiratory failure. They can tell you which signs and symptoms to watch for and how to manage your condition.

Go to the nearest emergency room or call 911 if you have symptoms of respiratory failure. It can be fatal if not treated quickly.

Can you survive respiratory failure?

Respiratory failure is a serious condition. But many people survive it, depending on what’s causing it, the severity and how quickly they’re treated.

Acute respiratory failure can be fatal if not treated quickly. An ongoing condition that gets worse over time usually causes chronic respiratory failure. Treating the underlying medical condition can help manage chronic respiratory failure.