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Respiratory Failure

(Lung Failure)


Bhakti K. Patel

, MD, University of Chicago

Reviewed/Revised Apr 2022 | Modified Sep 2022
Topic Resources

Respiratory failure is a condition in which the level of oxygen in the blood becomes dangerously low or the level of carbon dioxide in the blood becomes dangerously high.

  • Conditions that block the airways, damage lung tissue, weaken the muscles that control breathing, or decrease the drive to breathe may cause respiratory failure.

  • People may be very short of breath, have a bluish coloration to the skin, and be confused or sleepy.

  • Doctors use a fingertip sensor (pulse oximetry) to detect low levels of oxygen and blood tests to detect high levels of carbon dioxide in the blood.

  • Oxygen is given.

  • Sometimes people need the help of a machine to breathe (mechanical ventilation) until the underlying problem can be treated.

Acute respiratory failure is a medical emergency that can result from

  • Long-standing lung disease that suddenly gets worse

  • Severe lung disease that develops suddenly in otherwise healthy people

Causes of Respiratory Failure

Almost any condition that affects breathing or the lungs can lead to respiratory failure. Respiratory failure can occur in two ways:

  • The level of oxygen in the blood becomes too low (hypoxemic respiratory failure).

  • The level of carbon dioxide in the blood becomes too high (hypercarbic respiratory failure).

Sometimes people have both low oxygen and high carbon dioxide levels.


Low oxygen level (hypoxemic respiratory failure)

Hypoxemic respiratory failure can also occur if blood flow through the lungs becomes abnormal, as happens when a blood clot blocks a lung artery (pulmonary embolism Pulmonary Embolism (PE) Pulmonary embolism is the blocking of an artery of the lung (pulmonary artery) by a collection of solid material brought through the bloodstream (embolus)—usually a blood clot (thrombus) or... read more ). This disorder does not disrupt the usual ability of the lung tissues to take in oxygen, but without blood flowing to a portion of the lungs, oxygen is not properly extracted from the air.

High carbon dioxide level (hypercarbic respiratory failure)

With hypercarbic respiratory failure, the level of carbon dioxide is too high usually because something prevents the person from breathing normally. Common examples of such causes include the following:

Hypothyroidism, sleep apnea, and an overdose of opioids or alcohol all decrease the unconscious reflex that drives people to breathe. Blockage or narrowing of the airways can result from disorders (such as asthma Asthma Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are... read more Asthma and chronic obstructive pulmonary disease Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease is persistent narrowing (blocking, or obstruction) of the airways occurring with emphysema, chronic obstructive bronchitis, or both disorders. Cigarette... read more Chronic Obstructive Pulmonary Disease (COPD) ) as well as inhaled foreign objects. Injury to the chest or lungs, as well as weakness of the chest muscles (for example, in people with myasthenia gravis Myasthenia Gravis Myasthenia gravis is an autoimmune disorder that impairs communication between nerves and muscles, resulting in episodes of muscle weakness. Myasthenia gravis results from malfunction of the... read more , Guillain-Barre syndrome Guillain-Barré Syndrome (GBS) Guillain-Barré syndrome is a form of polyneuropathy causing muscle weakness, which usually worsens over a few days to weeks, then slowly improves or returns to normal on its own. With treatment... read more , or amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis (ALS) and Other Motor Neuron Diseases (MNDs) Motor neuron diseases are characterized by progressive deterioration of the nerve cells that initiate muscle movement. As a result, the muscles stimulated by these nerves deteriorate, become... read more [ALS]), can inhibit breathing and cause hypercarbic respiratory failure.

People who are not breathing adequately also may have a low oxygen level, but they are not considered to have hypoxemic respiratory failure if they do not also have a disorder of their lung tissue.

High levels of carbon dioxide tend to cause the blood to become more acidic and leads to abnormalities in body chemistry.

Did You Know?

  • Age-related reductions in lung function place older people at higher risk of severe symptoms after developing pneumonia.

Symptoms of Respiratory Failure

Hypoxemic respiratory failure and hypercarbic respiratory failure often cause similar symptoms. People are usually very short of breath. Low oxygen levels in the blood cause shortness of breath and result in a bluish coloration to the skin (cyanosis Cyanosis Cyanosis is a bluish or grayish discoloration of the skin resulting from an inadequate amount of oxygen in the blood. Cyanosis occurs when oxygen-depleted (deoxygenated) blood, which is bluish... read more ) in light-skinned people and gray or whitish coloration in the mouth, around the eyes, and under the nails in dark-skinned people. Low oxygen levels, high carbon dioxide levels, and increasing acidity of the blood cause confusion and sleepiness.

If the drive to breathe is normal, the body tries to rid itself of carbon dioxide by deep, rapid breathing. If the lungs cannot function normally, however, this breathing pattern may not help. Eventually, the brain and heart malfunction, resulting in drowsiness (sometimes to the point of becoming unconscious) and abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more Overview of Abnormal Heart Rhythms (arrhythmias), both of which can lead to death.

Some symptoms of respiratory failure vary with the cause. If the drive to breathe is abnormal (for example, after an overdose of alcohol or sedatives), people may be extremely sleepy, breathe too slowly, and quietly slip into a coma. A child with an obstructed airway due to the inhalation (aspiration) of a foreign object (such as a coin or a toy) may suddenly gasp and struggle for breath.

Diagnosis of Respiratory Failure

  • Measurements of the amount of oxygen and carbon dioxide in the blood

  • Chest x-ray and other tests to determine the cause

A doctor may suspect respiratory failure because of the symptoms and physical examination findings.

A test done on a sample of blood taken from an artery confirms the diagnosis of respiratory failure when it shows a dangerously low level of oxygen and/or a dangerously high level of carbon dioxide.

Chest x-rays and usually other tests are done to determine the cause of respiratory failure.

Treatment of Respiratory Failure

  • Supplemental oxygen

  • Mechanical ventilation

  • Treatment of the cause

Supplemental oxygen is given to correct any lack of oxygen in people with respiratory failure. Oxygen can be given using small plastic prongs placed in the nose (nasal cannula) or using a face mask, depending on how much oxygen people need. Oxygen is usually given initially in a greater amount than is needed and adjusted down later.

Mechanical ventilation Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more corrects the problem of ventilating the lungs (and decreases carbon dioxide levels) in people with hypercarbic respiratory failure. In mechanical ventilation, a machine (ventilator) is used to help air get in and out of the lungs. The air is delivered under pressure from the machine through a face mask (noninvasive positive pressure ventilation) or other device or through a tube placed in the windpipe (invasive positive pressure ventilation).

Doctors often try noninvasive methods first, but invasive mechanical ventilation may be necessary unless respiratory failure resolves rapidly with noninvasive treatment. Most people with respiratory failure are treated with both supplemental oxygen and some kind of mechanical ventilation.

The underlying disorder causing the respiratory failure must be treated. For example, antibiotics are used to fight pneumonia caused by bacterial infection, and bronchodilators are used in people with asthma to open the airways. Other drugs may be given, for example, to decrease inflammation or treat blood clots.

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