Respiratory Failure

What Is Respiratory Failure?

Respiratory Failure

Respiratory failure is a serious condition that makes it difficult to breathe on your own. Respiratory failure develops when the lungs can’t get enough oxygen into the blood.

We breathe oxygen from the air into our lungs, and we breathe out carbon dioxide, which is a waste gas made in the body’s cells. Breathing is essential to life itself. Oxygen must pass from our lungs into our blood for our tissues and organs to work properly.

Buildup of carbon dioxide can damage tissues and organs and prevent or slow oxygen delivery to the body.

Acute respiratory failure happens quickly and without much warning. It is often caused by a disease or injury that affects your breathing, such as pneumonia, opioid overdose, stroke, or a lung or spinal cord injury

Respiratory failure can also develop slowly. When it does, it is called chronic respiratory failure. Symptoms include shortness of breath or feeling like you can’t get enough air, extreme tiredness, an inability to exercise as you did before, and sleepiness.

A doctor may diagnose you with respiratory failure based on the oxygen and carbon dioxide levels in your blood, a physical exam to see how fast and shallow your breathing is and how hard you are working to breathe, as well as the results of lung function tests.

If you are diagnosed with a serious lung disease such as respiratory failure, you may need extra oxygen through tubes in your nose or support with a breathing machine called a ventilator.

What causes it?

Respiratory failure can be caused by several factors.

  • Conditions that make it difficult to breathe in and get air into your lungs: Examples include weakness following a stroke, collapsed airways, and food getting stuck in and blocking your windpipe.
  • Conditions that make it difficult for you to breathe out: Asthma causes your airways to narrow, while COPD can cause mucus to build up and narrow your airways. Both can make it hard for you to breathe out.
  • Lung collapse: When no air can enter your lungs, your lungs may collapse. This can happen in certain situations, such as when the muscles that you use to breathe become extremely weak, mucus blocks one of the large airways, or a rib is broken or fractured and severe pain makes it difficult to take a deep breath. 
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    Chest or lung injury can also cause air to leak from the lung, filling the space around it, which is called a pneumothorax.
  • Fluid in your lungs: This makes it harder for oxygen to pass from the air sacs into your blood and for carbon dioxide in your blood to pass into the air sacs to be breathed out. Pneumonia, acute respiratory distress syndrome (ARDS), drowning, and other lung diseases can cause this fluid buildup. It can also be caused by heart failure, which is when your heart can’t pump enough blood to the rest of your body. Severe head injury or trauma can also cause sudden fluid buildup in the lungs.
  • A problem with your breathing muscles: These problems can occur after a spinal cord injury or when you have a nerve and muscle condition such as muscular dystrophy.  This may also happen when your diaphragm and other breathing muscles do not get enough oxygen-rich blood, when the heart is not pumping well enough (cardiogenic shock), or when you get a severe infection called sepsis.
  • Conditions that affect the brain’s control over breathing: In opioid overdose, for example, the brain may not detect high levels of carbon dioxide in the blood. Normally, the brain would signal to you to deepen your breathing so that you breathe out the carbon dioxide. Instead, carbon dioxide builds up in the body while oxygen levels fall, leading to respiratory failure.

Diagnosis

Your doctor will ask you or your family members about your medical history and risk factors, especially any medical conditions that may affect your lungs and breathing. Your doctor will also ask if you have any symptoms of respiratory failure such as shortness of breath, rapid breathing, and confusion.

During a physical exam, your doctor may do the following:

  • Check for a bluish color on your lips, fingers, or toes.
  • Listen to your heart with a stethoscope to check for a fast or irregular heartbeat.
  • Listen to your lungs with a stethoscope for rapid breathing or any unusual sounds when you breathe. He or she will also see if your chest moves unevenly while you breathe.
  • Measure your blood oxygen level with a clip on a finger, called pulse oximetry.
  • Measure your blood pressure to check if it is too high or low.
  • Measure your temperature to check for a fever and ask if you have recently had a fever.

Diagnostic tests and procedures

To diagnose respiratory failure, your doctor may order some of the following tests and procedures.

  • Arterial blood gas tests measure levels of oxygen, carbon dioxide, pH, and bicarbonate. A sample of your blood will be taken from your arteries. These tests help determine whether you have respiratory failure and what type it is.
  • Blood tests can help find the cause of your respiratory failure. Blood tests can also help your doctor see how well your other organs are working.
  • Bacterial cultures can show a bacterial infection in samples of your blood, urine, or phlegm (a slimy substance that you cough out).
  • Bronchoscopy can show blockages, tumors, or other possible causes of respiratory failure.
  • Lung imaging tests show detailed images of the lungs and can reveal any possible inflammation or damage.
  • Heart tests such as electrocardiogram and echocardiography show how well your heart is working.
  • A lung biopsy shows changes in the cells of your lung tissue or tiny germs or microbes causing infections.
  • Lung function tests measure how well your lungs are working.
Treatment

Acute respiratory failure can be life-threatening and may need a quick diagnosis and emergency medical treatment in a hospital. Emergency treatment can help quickly improve your breathing and provide oxygen to your body to help prevent organ damage. Your healthcare provider will then treat the cause of your respiratory failure. Treatments for respiratory failure may include oxygen therapy, medicines, and procedures to help your lungs rest and heal.

Chronic respiratory failure can often be treated at home. If you have serious chronic respiratory failure, you may need treatment in a long-term care center.

Oxygen therapy

If you have respiratory failure, you may receive oxygen therapy. There are different ways to get oxygen into your lungs.

  • A noninvasive positive pressure ventilation (NPPV) uses mild air pressure to keep your airways open. You may wear plastic tubes on your nose, or a mask, or another device that fits over your nose or your nose and mouth. A tube connects the mask to a machine that blows air into the tube. Continuous positive airway pressure (CPAP) is one type of NPPV.
  • Bag mask ventilation uses a bag, which is attached to a mask that you wear, to pump more air into your lungs. This is often done while you are waiting for a complex procedure to treat the cause of your respiratory failure.
  • A mechanical ventilator is a machine that supports breathing. It blows air — or air with increased amounts of oxygen — into your airways and then your lungs. Your healthcare provider may treat you with a ventilator if the oxygen level in your blood doesn’t increase with NPPV, or if you’re still having trouble breathing. Using a ventilator, especially for a long time, can damage your lungs and airways and cause infections such as pneumonia.
  • A tracheostomy is a surgically made hole that goes through the front of your neck and into your windpipe. A breathing tube is placed in the hole to deliver oxygen when your airways are blocked.
  • Extracorporeal membrane oxygenation (ECMO) pumps your blood through an artificial lung to add oxygen and remove carbon dioxide before returning the blood to your body. Healthcare providers use ECMO to treat people with severe breathing problems. It may be used for several days or weeks to give the lungs a chance to recover. Some complications of ECMO are blood clots, bleeding, and infections, all of which can be life-threatening.
Medicines

Your doctor may prescribe medicines to improve your symptoms or treat the cause of your respiratory failure.

  • Antibiotics can treat bacterial lung infections such as pneumonia.
  • Bronchodilators work by opening your airways.
  • Corticosteroids control inflammation in the airways.
Treatments to manage other conditions or help you recover

If you have to stay in the hospital for a while, you may need treatments to avoid or manage other conditions or complications.

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  • Blood-thinning medicine: If you are very sick or got sick very quickly, this medicine can prevent blood clots from forming. If you cannot use a blood thinner for some reason, your doctor may order special stockings or devices to increase the pressure on your legs.
  • Fluids: Fluids improve blood flow throughout your body and keep you hydrated. Fluids are usually given through an intravenous (IV) line inserted in one of your blood vessels.
  • Nutritional support: You may need a feeding tube to make sure you get enough of the right nutrients while you are on a ventilator.
  • Physical therapy: This can help maintain muscle strength and prevent sores from forming. Movement may also help shorten the time you are on a ventilator and improve recovery after you leave the hospital.
  • Positioning your body: For severe respiratory failure, your doctor may recommend that you spend most of the time lying face down, which helps oxygen get to more of your lungs.
  • Pulmonary rehabilitation: This program of education and exercise teaches you breathing techniques that can improve your oxygen levels.

Source: https://www.nhlbi.nih.gov/health/respiratory-failure

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