An Overview of Respiratory Failure

Respiratory failure occurs when your lungs fail to do their job passing oxygen into your bloodstream and removing carbon dioxide. It is a common complication of chronic obstructive pulmonary disease (COPD) and other severe respiratory diseases.

Your lungs are responsible for bringing oxygen into your body, where it is picked up by your red blood cells and transported where it is needed. Meanwhile, carbon dioxide—the waste gas produced by your cells as they use the oxygen—moves from your bloodstream and back into your lungs, where you exhale it. This entire process is called gas exchange.

In respiratory failure, the gas exchange doesn't work the way it's supposed to work, and the cells in your body start to suffer from a lack of oxygen, too much carbon dioxide, or both. Too much carbon dioxide can disrupt the acid-base balance in the body, which in itself can lead to respiratory failure.

Symptoms

Symptoms of respiratory failure can either be acute (developing quickly) or chronic (occurring on an ongoing or recurring basis). The first symptom of respiratory failure you might notice is shortness of breath, referred to as dyspnea. Other symptoms include:

• Increased respiration rate
• Wheezing
• Confusion
• Fatigue and lethargy
• Sleepiness
• Anxiety
• A bluish tinge to your skin (cyanosis)
• Coughing up excess mucus

If your respiratory failure symptoms develop suddenly, you should medical seek help immediately. If your healthcare provider has told you that you have chronic respiratory failure as a result of COPD or other chronic conditions, you may be able to receive ongoing treatment at home or in a long-term care facility.

Causes

Respiratory failure can occur in one of two ways. There will either be too little oxygen in the blood (referred to as hypoxemic respiratory failure) or too much carbon dioxide in the blood (called hypercarbic respiratory failure).

Acute respiratory distress syndrome is a frequent cause of severe hypoxemia, while COPD is closely associated with hypercarbic hypoxemia.

Among the other possible causes of respiratory failure are:

• Airway obstruction
• Pneumonia
• Asthma
• Head trauma
• Severe obesity
• Stroke
• Pulmonary embolism
• Amyotrophic lateral sclerosis (ALS)
• Alcohol poisoning
• Drug overuse, including opiates and benzodiazepines

A condition doesn't need to affect the lungs directly in order to cause respiratory failure. For example, stroke, head injury, ALS, and drug/alcohol overdose can all affect the nervous system and muscles that control breathing.

There are two other forms of respiratory failure, called perioperative and postoperative respiratory failure. They can occur during or after surgery when a reaction to general anesthesia and intubation causes atelectasis (an underfilled lung).

Diagnosis

If your healthcare provider suspects respiratory failure, there are a number of tests he or she may order to confirm the diagnosis. They include:

• Chest X-ray
• Computed tomography (CT) scan of the chest
• Arterial blood gas test
• Pulse oximetry to detect low levels of oxygen
• Blood tests to detect high levels of carbon dioxide in the blood

Bronchoscopy, which involves the insertion of a flexible scope into the throat and lungs, may be used to check for infection in cases of acute respiratory failure.

Treatment

Once respiratory failure is confirmed, your treatment may include the following, depending on the underlying cause of your condition:

• Bronchodilators (which cause airway passages to open)
• Steroids (which help relax airway muscles)
• Antibiotics (if an infection is involved)
• Noninvasive positive-pressure ventilation (such as CPAP or BiPAP)
• Oxygen therapy
• A respirator or a non-invasive mask respirator

Once your condition is stable, your healthcare provider will talk to you about your long-term treatment options and prognosis. Your prospects for recovery will depend on the underlying cause of the failure, the severity of your condition, and the overall state of your health.

People with COPD who experience acute hypercapnic failure have an in-hospital mortality (death) rate of between 2% and 8% (up to 15% for those in intensive care) as well as a one-year mortality rate of 22% to 43%. People with severe acute respiratory distress syndrome have a mortality rate closer to 42%.

If you're a smoker, you will be advised to quit smoking immediately and given a referral to a smoking cessation program. Losing excess weight can also help reduce the risk of recurrence, especially if you are obese.