Respiratory Failure

Respiratory failure is a serious medical condition that occurs when your body cannot get enough oxygen into your blood or cannot remove enough carbon dioxide from it. This condition can develop suddenly or gradually over time, and while acute respiratory failure is life-threatening and requires immediate emergency care, chronic respiratory failure can often be managed at home with proper treatment and support.

Table of contents

• What is respiratory failure?
• Types of respiratory failure
• What causes respiratory failure?
• Symptoms of respiratory failure
• How is respiratory failure diagnosed?
• Treatment options
• Living with respiratory failure

What is respiratory failure?

Respiratory failure happens when your respiratory system (the organs and structures that help you breathe) cannot perform one or both of its main jobs: getting oxygen into your body and removing carbon dioxide from it^[1]. When you breathe normally, oxygen travels from the air into your lungs, then into your blood, and finally to your organs and tissues. At the same time, carbon dioxide—a waste product your body doesn’t need—moves from your blood into your lungs and is breathed out^[2].

You can think of this process like passengers traveling through an airport. Oxygen molecules arrive at small air sacs in your lungs called alveoli, where they are picked up by your blood. Your blood carries oxygen to your organs and muscles, which need it to function properly. After delivering oxygen, your blood picks up carbon dioxide and carries it back to your lungs, where you breathe it out to make room for more oxygen^[1].

When any part of this system fails, you may develop respiratory failure. Without enough oxygen reaching your tissues, or with too much carbon dioxide building up in your blood, your organs cannot work properly^[3].

Types of respiratory failure

Respiratory failure can develop suddenly (acute) or gradually over time (chronic). There are also different types based on what is happening in your blood^[1].

Hypoxemic respiratory failure (also called Type 1 respiratory failure) occurs when you don’t have enough oxygen in your blood. This is defined as having an oxygen level in your blood below 60 mmHg when breathing room air at sea level. Heart and lung conditions are the most common causes of this type. Examples include pneumonia, pulmonary edema (fluid in the lungs), and pulmonary hemorrhage (bleeding in the lungs)^[4][5].

Hypercapnic respiratory failure (also called Type 2 respiratory failure) happens when you have too much carbon dioxide in your blood—specifically, more than 45 mmHg on room air at sea level. If your body cannot get rid of carbon dioxide, there isn’t enough room in your blood to carry oxygen. Common causes include drug overdose, neuromuscular diseases, chest wall problems, and severe airway disorders such as asthma and chronic obstructive pulmonary disease (COPD)^[1][4].

Perioperative respiratory failure (Type 3) can occur during or after surgery. Anesthesia (medication that keeps you asleep during surgery) can affect your ability to breathe properly. Sometimes air sacs in your lungs can collapse, preventing oxygen from getting into your blood^[1].

Respiratory failure due to shock (Type 4) happens when a condition called shock causes low blood pressure, fluid in your lungs, and other problems. Sepsis, heart attack, and severe blood loss can all cause this type^[1].

Respiratory failure can also be classified based on how quickly it develops. Acute respiratory failure develops rapidly—over minutes to hours—and is life-threatening. Chronic respiratory failure develops more slowly, over days or longer, which allows your body time to adjust^[5].

What causes respiratory failure?

Many different conditions and situations can lead to respiratory failure. These conditions may affect your breathing muscles, nerves, bones, or the lung tissue itself^[3].

Lung diseases are common causes and include chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, pulmonary embolism (a blood clot in the lung), and COVID-19^[3].

Conditions affecting the nerves and muscles that control breathing can also cause respiratory failure. These include amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke^[3].

Problems with the spine, such as scoliosis (a curve in the spine), can affect the bones and muscles used for breathing. Damage to the tissues and ribs around the lungs—for example, from a chest injury—can also lead to respiratory failure^[3].

Other causes include drug or alcohol overdose, inhalation injuries from breathing in smoke from fires or harmful fumes, and cardiac conditions such as heart failure^[3][4].

Low oxygen in the environment, such as at high altitude, can also contribute to respiratory failure^[4].

Symptoms of respiratory failure

The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood^[1].

When oxygen levels are low in your blood, you may experience shortness of breath or a feeling that you cannot get enough air (called dyspnea). Your skin, lips, and fingernails may also turn a bluish color, a sign called cyanosis^[2][3].

High carbon dioxide levels can cause rapid breathing (called tachypnea) and confusion. Some people become very sleepy or lose consciousness. You may also experience irregular heartbeat (called arrhythmia) if your brain and heart are not getting enough oxygen^[3].

Other common symptoms include extreme tiredness, wheezing, coughing, large amounts of mucus, chest tightness or pain, and trouble with daily activities such as walking, cooking, or dressing^[1][2].

Acute respiratory failure is a medical emergency. Call 911 or go to the nearest emergency room immediately if you suddenly have trouble breathing, feel very confused, or if you or someone you’re with develops a bluish color on their skin or lips^[1][2].

How is respiratory failure diagnosed?

Your healthcare provider will diagnose respiratory failure based on your medical history, a physical exam, and diagnostic tests^[3].

During the physical exam, your provider will listen to your lungs to check for abnormal sounds and listen to your heart to check for irregular heartbeat. They will also look for a bluish color on your skin, lips, and fingernails, and check how fast and hard you are breathing^[2][3].

Important diagnostic tests include pulse oximetry, which uses a small sensor placed on your finger or ear to measure how much oxygen is in your blood. An arterial blood gas test measures the levels of oxygen and carbon dioxide in your blood. For this test, a blood sample is taken from an artery, usually in your wrist^[3].

Once respiratory failure is diagnosed, your provider will look for the underlying cause. Tests often include a chest x-ray. If your provider suspects you have an irregular heartbeat because of respiratory failure, you may have an electrocardiogram (EKG), a simple, painless test that detects and records your heart’s electrical activity^[3].

Treatment options

Treatment for respiratory failure depends on whether it is acute or chronic, how severe it is, and what is causing it^[3].

Acute respiratory failure can be a medical emergency. You may need treatment in an intensive care unit at a hospital. Chronic respiratory failure can often be treated at home, but if it is severe, you might need treatment in a long-term care center^[3].

One of the main goals of treatment is to get oxygen to your lungs and other organs and to remove carbon dioxide from your body. Another goal is to treat the underlying cause of the condition^[3][9].

Oxygen therapy is a common treatment. There are different ways to deliver oxygen into your lungs. You might receive oxygen through plastic tubes placed in your nose, or through a mask that fits over your nose or mouth. Some people use a machine called a noninvasive positive pressure ventilation device, which uses mild air pressure to keep airways open^[9].

If oxygen levels don’t improve with these methods, a mechanical ventilator may be needed. This machine supports breathing by blowing air—or air with extra oxygen—into your airways and lungs. Using a ventilator, especially for a long time, can sometimes damage your lungs^[9].

Medications may also be part of your treatment plan. These can include inhaled medicines delivered through an inhaler or a machine called a nebulizer to help open your airways. Other medications can help prevent worsening of lung function and improve how well your lungs work^[12].

In some cases, fluids are given through an IV to ensure you have the right amount of fluid in your body. This supports proper blood flow without causing fluid to build up in the lungs^[12].

Your healthcare team will work to treat the specific disease or condition causing your respiratory failure, whether that’s an infection, heart problem, or other underlying issue^[5].

Living with respiratory failure

If you have chronic respiratory failure, you may need ongoing care to prevent damage to your lungs and other organs. You might have to carry a portable oxygen tank and tube (called a cannula) that goes into your nose^[17].

As you recover from respiratory failure, it is important to follow your treatment plan and get regular follow-up care. Your oxygen and carbon dioxide levels may take a while to return to a healthy range. Because of this, you may continue to have shortness of breath or other symptoms for several weeks or longer. You may need to do daily activities more slowly^[17].

If your symptoms suddenly get worse, call 911 for help immediately if you have trouble breathing or talking^[17].

Your doctor may talk to you about pulmonary rehabilitation, which is an exercise training, education, and counseling program that can help your lungs work better^[17].

To prevent complications, it’s important to quit smoking if you smoke. Talk to your healthcare provider about programs and products that can help you quit^[17].

If you used a mechanical ventilator, watch for warning signs of complications. Using a ventilator for a long time may hurt your lungs and windpipe^[17].

Many people living with chronic respiratory conditions find ways to adapt and maintain quality of life. Making your home environment safer by improving air quality, keeping emergency contacts visible, and ensuring rooms are easy to navigate can all help. Planning ahead for emergencies and working closely with your healthcare team are essential steps in managing respiratory failure at home^[8].