Respiratory Failure

Overview

Man in a hospital bed on a respirator

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

Respiratory failure is a serious condition that develops when the lungs can’t get enough oxygen into the blood. Buildup of carbon dioxide can also damage the tissues and organs and further impair oxygenation of blood and, as a result, slow oxygen delivery to the tissues.

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. Acute respiratory failure requires emergency treatment. Call 9-1-1 if you suddenly experience trouble breathing, feel confused, or if your family and/or caregivers notice a bluish color on your skin or lips.

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, fatigue (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, how fast and shallow your breathing is, the results of lung function tests, and other aspects, such as how hard you are working to breathe.

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

Explore this Health Topic to learn more about respiratory failure, our role in research and clinical trials, and where to find more information.

Causes - Respiratory Failure

Any condition or injury that affects breathing can cause respiratory failure. The condition or injury may affect your airways or lungs. Or it may affect the muscles, nerves, and bones that help you breathe.

When you can't breathe well, your lungs can’t easily move oxygen into your blood or remove carbon dioxide. This causes a low oxygen or high carbon dioxide level in your blood. Learn more about how your lungs normally exchange oxygen and carbon dioxide in this video.

When you breathe in, air enters your nose or mouth, and passes into your windpipe, also called the trachea. At the bottom, the windpipe divides into two bronchial tubes, or bronchi, then branches into smaller bronchioles. The bronchioles end in tiny air sacs, called alveoli. Here the oxygen you inhale passes into the bloodstream, and carbon dioxide from your body passes out of the bloodstream. The carbon dioxide is expelled from your body when you exhale. Visit How the Lungs Work to learn more. Medical Animation Copyright © 2019 Nucleus Medical Media Inc. All rights reserved.

Respiratory failure can be caused by:

  • 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 buildup and narrow your airways, which can make it hard for you to breathe out.
  • Lung collapse. When no air is able to enter your lungs, one or both lobes may collapse and cause a condition called atelectasis. This collapsing of the lung can happen in certain situations, such as when the lungs become extremely weak, mucus blocks one of the large airways, a rib is broken or fractured, or severe pain in the lung makes it difficult to take a deep breath. Chest trauma or lung injury can also cause air to leak from the lung, filling the space around the lung within the chest. This air could cause the lung to collapse, 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 the inability of the heart to pump enough blood to the lungs (called heart failure). Severe head injury or trauma can also cause sudden fluid buildup in the lungs.
  • A problem with your breathing muscles. Such problems can occur after a spinal cord injury or when you have a nerve and muscle condition such as muscular dystrophy. It can 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.

Risk Factors - Respiratory Failure

You may have an increased risk of respiratory failure because of your age, environment or occupation, lifestyle habits, and other medical conditions or medicines and procedures.

Age

Premature babies who have neonatal respiratory distress due to an under-developed lung, pulmonary hypertension, or certain lung birth defects have a higher risk of respiratory failure. Older adults have more risk factors for respiratory failure. It is more likely that food will accidentally go down the windpipe instead of the food pipe or that a cold will lead to a severe chest infection. Older adults are also more likely to have muscle weakness that can affect breathing.

Environment or occupation

Breathing in lung irritants can lead to lung damage over the long term and put you at risk of serious lung diseases. You may breathe in these irritants from the air where you live or work.

Lung irritants include air pollution, chemical fumes, asbestos, aniline dyes and paints, dust, and secondhand smoke (smoke in the air from other people smoking).

Other medical conditions

You may have a greater risk of respiratory failure if you have certain medical conditions or injuries.

Many other serious health conditions can also raise your risk. This includes coronary heart disease, kidney or liver disease, or a weakened immune system.

Lifestyle habits

Smoking can cause lung diseases that raise your risk of respiratory failure.

Using drugs or alcohol raises your risk of an overdose. A drug or alcohol overdose affects the area of the brain that controls breathing. During an overdose, breathing becomes slow and shallow, and this can cause acute respiratory failure. This can happen from using illegal drugs or misusing prescription opioid painkillers.

Medicines or medical procedures

Certain sedatives used during surgery affect your breathing. This can put you at risk of respiratory failure, especially if you have other risk factors.

Complications from major surgery can also raise your risk of respiratory failure.

Screening and Prevention - Respiratory Failure

If you have a condition that puts you at risk of respiratory failure, talk to your doctor. He or she can ask questions and do a physical exam to look for issues that may put you at risk of getting respiratory failure in the future. Your doctor can also talk to you about how to manage your condition to prevent respiratory failure. He or she can also screen you if you have a planned surgery.

How to prevent respiratory failure

If you have COPD or another condition that raises your risk of respiratory failure, it is very important to follow your treatment plan.

There are things you can do to keep your lungs healthy, including quitting or not smoking, limiting alcohol, and not misusing opioids or taking illegal drugs. Learn about additional ways to keep your lungs healthy in our How the Lungs Work Health Topic.

Your doctor may also talk to you about other healthy lifestyle changes that can help lower your risk. This may include being physically active, choosing a diet such as the DASH eating plan, aiming for a healthy weight, managing stress, and getting good-quality sleep.

Signs, Symptoms, and Complications - Respiratory Failure

Symptoms of respiratory failure depend on its cause, the levels of oxygen and carbon dioxide in your blood, and whether respiratory failure developed slowly over time or suddenly. You may start out with mild symptoms such as shortness of breath or rapid breathing, which may get worse over time. Acute respiratory failure can be a life-threatening emergency. Respiratory failure may cause damage to your lungs and other organs, so it is important to get treated quickly.

Signs and symptoms

Low oxygen levels in your blood can cause:

  • Difficulty or extreme tiredness with routine activities such as dressing, taking a shower, and climbing stairs
  • Shortness of breath or feeling like you cannot get enough air (called air hunger)
  • Drowsiness
  • A bluish color on your fingers, toes, and lips

High carbon dioxide levels in your blood can cause:

  • Blurred vision
  • Confusion
  • Headaches
  • Rapid breathing

You can have symptoms of low oxygen and high carbon dioxide at the same time. Some people who have respiratory failure become extremely sleepy or lose consciousness if their brain does not get enough oxygen or if carbon dioxide levels are very high.

Symptoms of respiratory failure in newborns include rapid breathing, grunting, widening of the nostrils with each breath, a bluish tone to your baby's skin and lips, and a pulling inward of the muscles between the ribs between the ribs while breathing. 

Complications

Respiratory failure can cause serious or life-threatening problems such as:

  • Arrhythmias (irregular heartbeats)
  • Brain injury
  • Kidney failure
  • Lung damage

Diagnosis - Respiratory Failure

Your doctor will check your medical history, perform a physical exam, and do tests and procedures to diagnose respiratory failure.

Medical history

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.

Physical exam

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 to 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 to 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 using samples of your blood, urine, or phlegm (a slimy substance that you cough out) to check for a bacterial infection.
  • Bronchoscopy to check for blockages, tumors, or other possible causes of respiratory failure.
  • Chest X-ray to identify any lung or heart conditions that may be causing respiratory failure.
  • Chest computed tomography (CT) scan to image the lungs and look for inflammation or damage.
  • Electrocardiogram (EKG or ECG) to check your heart rhythm and how well your heart is working.
  • Echocardiography to check how well your heart is working.
  • Lung ultrasound to check for lung conditions such as pleural effusion.
  • Lung biopsy to collect samples of your lung tissue.
  • Pulmonary function tests to measure how well your lungs are working

Treatment - Respiratory Failure

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 team 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 the oxygen into your lungs, depending on how severe your respiratory failure is.

  • Plastic tubes that rest in your nose, called a nasal cannula, attached to a portable oxygen tank. You may need a special system to get a higher flow of oxygen, called a high flow nasal canula.
  • Bag mask ventilation. You may wear a mask attached to a bag to get 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.
  • Noninvasive positive pressure ventilation (NPPV). This treatment uses mild air pressure to keep your airways open while you sleep. You wear 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. For more information, visit the CPAP Health Topic. Although it focuses on CPAP treatment for sleep apnea, it explains how CPAP works.
  • A mechanical ventilator, if the oxygen level in your blood doesn’t increase, or if you're still having trouble breathing. A ventilator is a machine that supports breathing. It blows air—or air with increased amounts of oxygen—into your airways and then your lungs. Using a ventilator, especially for a long time, can damage your lungs and airways and cause infections such as pneumonia.
  • A tracheostomy to deliver oxygen, if your airways are blocked. A tracheostomy is a surgically made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy or trach tube, is placed in the hole to help you breathe.
Figure A shows a side view of the neck and the correct placement of a tracheostomy tube in the windpipe. Figure B shows an outside view of a person who has a tracheostomy.
Figure A shows a side view of the neck and the correct placement of a tracheostomy tube in the windpipe. Figure B shows an outside view of a person who has a tracheostomy.
  • Extracorporeal membrane oxygenation (ECMO). People with severe breathing problems may need ECMO. This treatment pumps your blood through an artificial lung to add oxygen and remove carbon dioxide before returning the blood to your body. 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. These may include:

  • Antibiotics to treat bacterial lung infections such as pneumonia.
  • Bronchodilators to open your airways or treat an asthma attack.
  • Corticosteroids to shrink swollen airways and treat any inflammation.

Other treatments

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

  • Fluids. You may be given fluids to improve blood flow throughout your body. 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 facedown, 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.
  • 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.

Living With - Respiratory Failure

For both acute (short-term) and chronic (long-term) respiratory failure, it is important to follow your treatment plan, manage your condition, and know when you should seek medical care. You may need pulmonary rehabilitation to help your lungs work better.

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 a few weeks or longer. You may need to do daily activities more slowly.

Manage your condition

Using a mechanical ventilator for a long time may hurt your lungs and windpipe. You may need follow-up care for these complications. As you recover at home, watch to see if they develop.

If you have chronic respiratory failure, you will likely need ongoing care. Ask your doctor how often you will need it. You may also have to carry a portable oxygen cannula and tank with you.

For either acute or chronic respiratory failure, your doctor may refer you to pulmonary rehabilitation. This is an exercise training, education, and counselling program that can help your lungs work better.

Your doctor may talk to you about ways to prevent complications in the future, especially if you have chronic respiratory failure.

  • Quit smoking. Talk to your doctor about programs and products that can help you quit smoking. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
  • Avoid lung irritants, such as air pollution, chemical fumes, dusts, and secondhand smoke.
  • Avoid or limit alcohol. Talk to your doctor about how much alcohol you drink. Your doctor may recommend that you limit or stop drinking alcohol. You can find resources and support at the Alcohol Treatment Navigator from the National Institute on Alcohol Abuse and Alcoholism. You should also avoid illegal drugs. Visit the Step by Step Guides to Finding Treatment for Drug Use Disorders from the National Institute on Drug Abuse for help.
  • Get recommended vaccines. Your doctor may ask you and anyone who lives with you to get regular vaccines, a vaccine for pneumococcus, and a flu shot every year.

For more information about keeping your lungs healthy, visit our How the Lungs Work Health Topic.

Know when to seek help

If you have chronic respiratory failure, your symptoms may suddenly get worse. Call 9-1-1 for help if you suddenly have trouble breathing or talking.

Keep phone numbers handy for your doctor, the hospital, and someone who can take you for medical care. You should also have directions to the doctor's office and hospital and a list of all the medicines you're taking on hand.

Take care of your mental health

Living with chronic respiratory failure may cause fear, anxiety, depression, and stress. Talk about how you feel with your healthcare team or a professional counselor. They can help you find or learn ways to cope.

  • Get treatment for depression. If you are depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
  • Join a patient support group. You can learn how other people who have the similar symptoms have coped with them. Your doctor may be able to help you find local support groups, or you can check with an area medical center.
  • Seek support from family and friends. Letting your loved ones know how you feel and what they can do to help you can help lower stress and anxiety.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies on respiratory failure. See if you or someone you know is eligible to participate in our clinical trials.

Do you or a loved one have pneumonia?

This study will test whether combining two medicines to reduce inflammation of the airway and to keep it open may help prevent respiratory failure in people who have pneumonia. To participate in this study, you must be at least 18 years old and have severe pneumonia with low blood oxygen levels. This study is located in Scottsdale and Tucson, Arizona; Palo Alto, California; Gainesville and Jacksonville, Florida; Baltimore, Maryland; Rochester, Minnesota; New York, New York; Durham, North Carolina; and Philadelphia, Pennsylvania.
View more information about ARrest RESpiraTory Failure From PNEUMONIA.

Are you being treated in the ICU for acute respiratory failure?

This study is looking at whether treating depression along with physical therapy helps people recover faster from respiratory failure. After leaving the ICU, you will be visited at your home by a physical therapist and occupational therapist who will talk to you about your goals for recovery and what activities you value the most. They will then design a plan for you that includes a type of talk therapy for depression called behavioral activation. To participate in this study, you must be at least 18 years old and undergoing treatment for acute respiratory failure for more than 24 hours in the ICU. This study is located in Baltimore, Maryland.

Is your child on a ventilator at Children’s Hospital Los Angeles?

Ventilators can sometimes weaken the muscles around the lungs, especially in children. This study is testing whether a new computer method to control ventilators can help prevent muscle weakness in children. To participate in this study, your child must be between 1 month and 18 years old and have been on a ventilator for less than 48 hours (or 72 if they were transferred from another hospital) because of a serious lung disease. This study is located in Los Angeles, California.

Are you or a loved one on a ventilator in the hospital in Minnesota?

This study is finding out whether people who are on a ventilator sleep better and have less anxiety if they can control their own sedation medicine. To participate in this study, you must be at least 18 years old and receiving mechanical ventilation while hospitalized. This study is located in Minneapolis and Rochester, Minnesota.

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