Providers may use medications or procedures to treat respiratory failure, including:
Acute Respiratory Failure: Types, Symptoms, Treatment
Signs of acute respiratory failure include dizziness, shortness of breath, and a bluish discoloration of your extremities. It can be life threatening and requires immediate medical care.
Acute respiratory failure occurs when your lungs cannot release enough oxygen into your blood, which prevents your organs from properly functioning. It also occurs if your lungs cannot remove carbon dioxide from your blood.
Respiratory failure happens when the capillaries, or tiny blood vessels surrounding your air sacs, cannot properly exchange carbon dioxide and/or oxygen.
There are two types of respiratory failure: acute and chronic.
Acute respiratory failure happens suddenly. It occurs due to a disease or injury that interferes with the ability of the lungs to deliver oxygen or remove carbon dioxide. In most cases, acute respiratory failure can be fatal if not treated quickly.
Chronic respiratory failure has multiple causes. It can occur when the airways narrow or become damaged over time. It can also occur with conditions that cause the respiratory muscles to weaken over time. Some causes of chronic respiratory failure include:
- damaged and/or narrow airways, which can occur in conditions like:
- chronic obstructive pulmonary disease (COPD)
- bronchiectasis
- asthma
- cystic fibrosis
- pneumonia
- interstitial lung disease
There are two types of acute and chronic respiratory failure: hypoxemic and hypercapnic. Both conditions can trigger serious complications, and they often occur together.
Hypoxemic respiratory failure, or hypoxemia, occurs when you do not have enough oxygen in your blood.
Hypercapnic respiratory failure, or hypercapnia, happens when there is too much carbon dioxide in your blood.
The symptoms of acute respiratory failure depend on its underlying cause. Symptoms can also differ by the amount of oxygen and carbon dioxide in your blood.
People with low oxygen may experience :
- shortness of breath
- a bluish coloration on lips, fingertips, or toes
- drowsiness
- difficulty performing routine activities, such as dressing or climbing stairs, due to extreme tiredness
People with high carbon dioxide levels may experience:
- rapid breathing
- confusion
- blurred vision
- headaches
Acute respiratory failure has several causes:
Obstruction
When something lodges in your throat, you may have trouble getting enough oxygen into your lungs. Obstruction can also occur in people with COPD or asthma when an exacerbation causes the airways to narrow.
Injury
An injury that impairs or compromises your respiratory system can negatively affect the amount of oxygen or carbon dioxide in your blood.
For instance, a spinal cord or brain injury can immediately affect your breathing. If the brain cannot relay messages to the lungs, the lungs may not function properly.
Rib or chest injuries can also affect your breathing.
Acute respiratory distress syndrome
Acute respiratory distress syndrome (ARDS) is a serious condition that causes fluid to build up in your lungs. It results in low oxygen in the blood. People who develop ARDS typically have an underlying health condition, such as:
- pneumonia
- pancreatitis
- sepsis
- trauma to the head or chest
- blood transfusions
- near drowning
- lung injuries related to inhaling smoke or chemical products
Drug or alcohol use
Experiencing a drug overdose or drinking too much alcohol can also impair brain function and hinder breathing.
Chemical inhalation
Inhaling toxic chemicals, smoke, or fumes can cause acute respiratory failure. These chemicals may injure or damage lung tissue, including the air sacs and capillaries.
Stroke
A stroke happens when something disrupts blood flow to the brain. Strokes often affect only one side of the brain.
Although strokes present with some warning signs, such as slurred speech or confusion, they typically occur suddenly. If you have a stroke, you can lose the ability to breathe.
Infection
Infections can cause respiratory distress. Pneumonia, in particular, may cause respiratory failure, even without ARDS.
You may be at risk for acute respiratory failure if you:
- smoke tobacco products
- drink alcohol excessively
- have a family history of respiratory disease or conditions
- have an injury to the spine, brain, or chest
- have a compromised immune system
- have chronic respiratory conditions, such as lung cancer, COPD, or asthma
Acute respiratory failure requires immediate medical attention. You may require supplemental oxygen to help you breathe and prevent organ damage.
When you’re in stable condition, a doctor may diagnose you by:
- performing a physical exam
- asking questions about your personal or family health history
- checking your body’s oxygen and carbon dioxide levels with a pulse oximetry device and an arterial blood gas test
- ordering a chest X-ray of your lungs
Because acute respiratory failure means your organs are not receiving the oxygen-rich blood they need to function, complications can involve multiple organ systems. Acute respiratory failure can often be fatal.
Pulmonary complications, or those affecting the lungs, can include:
- pulmonary embolism
- pulmonary fibrosis
- pneumonia
- pneumothorax (collapsed lung)
Other complications can include:
- gastrointestinal hemorrhage
- renal (kidney) failure
- hepatic (liver) failure
Doctors must treat acute respiratory failure quickly, as it can be life threatening. Emergency medical treatment can help you breathe and prevent further organ damage.
Once you’re in stable condition, a doctor can treat any underlying conditions causing your respiratory failure.
Depending on any underlying conditions, a doctor can treat you in multiple ways, including the following scenarios:
- If you’re in pain or having difficulty breathing, a doctor may prescribe pain medication or other medications to help you breathe better.
- If you cannot breathe adequately, a doctor may insert a breathing tube into your mouth or nose and connect the tube to a ventilator to help you breathe.
- If you can adequately breathe on your own and your hypoxemia (low blood oxygen) is mild, you may need supplemental oxygen from an oxygen tank to help you breathe better. This may include a portable air tank.
- If you require prolonged ventilator support, you may need a tracheostomy. This operation creates an artificial airway in your windpipe.
Acute respiratory failure can cause long-term damage to your lungs.
It may take several weeks for your oxygen and carbon dioxide levels to reach a healthy range. You may also require pulmonary rehabilitation, which can include:
- exercise therapy
- education
- counseling
The following include questions commonly asked about acute respiratory failure.
Can you recover from acute respiratory failure?
You can recover from acute respiratory failure, but immediate medical attention is essential. Your recovery treatment plan may include treatment for any physical trauma from the respiratory failure, the cause of the respiratory failure, and any procedures or medications you received while in the hospital.
Additionally, some people may experience post-intensive care syndrome (PICS) after a life threatening condition. PICS can include:
- physical issues
- cognitive issues
- mental health issues
Is acute respiratory failure a cause of death?
Acute respiratory failure can result in death if you do not treat it quickly. If you experience any acute respiratory failure symptoms, seek immediate medical care.
How long does respiratory failure last?
Acute respiratory failure is a short-term medical condition. It happens suddenly and requires immediate treatment. Chronic respiratory failure is an ongoing condition.
Acute respiratory failure requires immediate medical attention and can be fatal.
Causes can include an injury or obstruction to your airway. Symptoms may include shortness of breath or dizziness. You may also experience severe drowsiness.
Once you are in stable condition, a doctor can treat any underlying conditions causing respiratory failure. They may recommend medication and breathing support to improve your breathing ability.
Last medically reviewed on January 4, 2023
Respiratory Failure
Respiratory failure is a condition where there’s not enough oxygen or too much carbon dioxide in your body. It can happen all at once (acute) or come on over time (chronic). Many underlying conditions can cause it. Acute respiratory failure is life-threatening. Call 911 or go to the nearest ER if you think you’re experiencing respiratory failure.
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Overview
What is respiratory failure?
Respiratory failure is a condition where you don’t have enough oxygen in the tissues in your body (hypoxia) or when you have too much carbon dioxide in your blood (hypercapnia). You might also hear people use the term “acute hypoxemic respiratory failure (AHRF)” to describe it.
Respiratory failure is often a medical emergency. Call 911 or seek medical attention right away if you think you’re experiencing respiratory failure.
How respiration works
You can think of respiration as passengers traveling from the air to your tissues. When you breathe in, oxygen molecules travel to your lungs — the passengers arriving at the airport. The oxygen passengers arrive at the “airport gates” — small air sacs around your lungs called alveoli — and are picked up by your blood. They travel through your blood to their final destination in your tissues, like your organs and muscles. You need oxygen to reach its destination to stay alive.
After your blood cells drop off oxygen in your tissues, they have room to pick up carbon dioxide. Your body doesn’t need carbon dioxide (it’s a waste product). If too much of it builds up, there isn’t room in your blood’s transportation system to deliver oxygen. Your blood circulates through your body, back to your lungs, where it drops off carbon dioxide. When you breathe out, you get rid of the unnecessary waste to make room for more oxygen.
If any parts of this system fail, you won’t have enough oxygen to keep your tissues healthy.
What are the types of respiratory failure?
Respiratory failure can come on suddenly (acute) or over time (chronic). There are two common types: hypoxemic respiratory failure (type 1) and hypercapnic respiratory failure (type 2). Other types include perioperative (related to surgery) respiratory failure (type 3) and respiratory failure due to shock (type 4).
Hypoxemic respiratory failure
Hypoxemic respiratory failure happens when you don’t have enough oxygen in your blood (hypoxemia). Heart and lung conditions are the most common causes. Hypoxemic respiratory failure is also called hypoxic respiratory failure.
Hypercapnic respiratory failure
Hypercapnic respiratory failure happens when you have too much carbon dioxide (CO2) in your blood. If your body can’t get rid of carbon dioxide, a waste product, there isn’t room for your blood cells to carry oxygen.
The most common causes of hypercapnic respiratory failure include heart, lung, muscle and neurological (brain and spinal cord) conditions. Certain medications can also cause it. Hypercapnic respiratory failure is also called hypercarbic respiratory failure.
Perioperative respiratory failure
Perioperative respiratory failure can happen when you have surgery. Anesthesia (medication that keeps you asleep) can keep you from breathing properly. Sometimes, air sacs in your lungs can collapse (atelectasis) and keep oxygen from getting into your blood.
Respiratory failure due to shock
Shock is a condition that causes low blood pressure, fluid in your lungs (pulmonary edema) and other issues that can lead to respiratory failure. Sepsis, cardiac events (like a heart attack) and blood loss can cause shock.
Symptoms and Causes
What are the symptoms of respiratory failure?
Symptoms of respiratory failure depend on the cause. Symptoms may include:
- Shortness of breath or feeling like you can’t get enough air (dyspnea).
- Rapid breathing (tachypnea).
- Extreme tiredness (fatigue).
- Fast heart rate (feeling like your heart’s racing) or heart palpitations.
- Spitting or coughing blood or bloody mucus (hemoptysis).
- Excessive sweating.
- Restlessness.
- Pale skin.
- Bluish skin, lips or nails (cyanosis).
- Headaches.
- Blurred vision.
- Agitation, confusion or being unable to think straight.
- Behavioral changes, not acting like yourself.
What causes respiratory failure?
Respiratory failure happens when something keeps your body from getting oxygen into your blood or getting carbon dioxide out of your blood. This can be due to:
- Too little airflow or blood flow to your lungs.
- Blockages, scarring or fluid in your lungs.
- Inability to breathe properly or deeply enough. Conditions that affect your lungs, issues with the nerves or muscles you use to breathe, or injuries to your chest can cause this.
- Abnormalities in the way blood flows through your heart.
Risk factors for respiratory failure
Risk factors for respiratory failure include:
- Lung conditions and diseases. This includes acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), pneumonia, asthma, cystic fibrosis, pulmonary edema, pulmonary embolism and pulmonary fibrosis.
- Heart or circulatory (blood flow) conditions and diseases. This includes heart attack, congenital heart disease,heart failure and shock.
- Conditions that affect the nerves and muscles that help you breathe. This includes muscular dystrophy, amyotrophic lateral sclerosis (ALS), severe scoliosis and Guillain-Barré syndrome.
- Chest, spinal cord or brain injuries (including stroke).
- Smoking or exposure to other lung irritants. This includes chemical fumes, dust, air pollution and asbestos.
- Surgery that requires sedation or anesthesia.
- Drug use or excessive alcohol consumption.
- Age. Newborn babies (especially premature infants) and adults over 65 are at higher risk for respiratory failure.
Diagnosis and Tests
How is respiratory failure diagnosed?
A provider diagnoses respiratory failure by testing the amount of oxygen and carbon dioxide in your blood. They’ll check your blood pressure and use a small device (pulse oximeter, or pulse ox) on your finger to check your oxygen levels. They’ll listen to your heart and lungs and examine you. You may need further tests if your provider thinks you have respiratory failure.
What tests will be done to diagnose respiratory failure?
Your provider may perform some or all of the following tests to help diagnose respiratory failure:
- Pulse oximetry: A sensor slips over your finger to measure the amount of oxygen in your blood. Providers often check this each time you visit.
- Arterial blood gas (ABG) test: A needle is used to take a blood sample from your wrist, arm or groin to measure the levels of oxygen and carbon dioxide in your blood.
- Lung function tests. Also called pulmonary function tests (PFT), your provider may have you breathe into a mouthpiece attached to a machine to test how well your lungs work.
- Imaging. Your provider may use X-rays and CT scans to get images of the inside of your body. These don’t diagnose respiratory failure, but they can help your provider know what’s causing it.
- Electrocardiogram (EKG). An EKG tests how well your heart is working. If your provider thinks a heart condition is causing respiratory failure, they may have you get an EKG.
Management and Treatment
How is respiratory failure treated?
How providers treat respiratory failure depends on how severe it is and what’s causing it. Treatments focus on managing the underlying cause, giving you more oxygen, or using mechanical ventilation to breathe for you until you’re able to on your own again.
Acute respiratory failure is an emergency and needs to be treated right away. Mild chronic respiratory failure can often be treated at home by managing the condition that’s causing it.
Specific treatments for respiratory failure
Providers may use medications or procedures to treat respiratory failure, including:
- Mechanical ventilation. Providers use a breathing machine and a tube that goes into your airways to move air in and out of your lungs.
- Extracorporeal membrane oxygenation (ECMO). Providers use a bypass machine to add oxygen to your blood and remove carbon dioxide.
- Oxygen therapy. A machine delivers extra oxygen through a breathing mask or small tube (cannula). You may get oxygen at home or in the hospital.
- Fluids. Your provider can give you fluids through an IV (directly to a vein). This can improve the blood flow through your body, bringing more oxygen to your tissues.
- Managing underlying conditions. You provider may treat you with other medications or procedures, depending on what’s causing respiratory failure.
Prevention
Can respiratory failure be prevented?
You can’t always prevent respiratory failure. You can lower your risk of chronic respiratory failure by managing ongoing heart, lung and neurological conditions. Talk to your healthcare provider about ways to reduce your risk if you have a condition that can cause respiratory failure.
Outlook / Prognosis
Can you survive respiratory failure?
Respiratory failure is a very serious condition. Many people survive it, depending on what’s causing it, the severity and how quickly they’re treated.
While many causes of acute respiratory failure are treatable, it can be fatal if not treated quickly. Up to 1 in 3 people who are hospitalized for acute respiratory failure don’t survive. Chronic respiratory failure is usually caused by an ongoing condition that gets worse over time.
Frequently Asked Questions
When should I see a healthcare provider?
Talk to a healthcare provider if you have a chronic condition that puts you at risk for respiratory failure. They can tell you what signs and symptoms of respiratory failure to look out for and how to manage your condition.
When should I go to the ER?
Go to the nearest emergency room or call 911 if you have symptoms of respiratory failure. It can be fatal if not treated quickly.
What questions should I ask my doctor?
It might be helpful to ask your provider:
- What are my treatment options?
- What caused this?
- How do I take my medications?
- How do I use this device? Can you demonstrate?
- When can I expect to feel better?
- When should I follow up with you?
A note from Cleveland Clinic
Respiratory failure is a serious condition that can be fatal. If you think you’re experiencing acute respiratory failure, call 911 or seek emergency medical attention. If you have chronic respiratory failure or conditions that could increase your risk of developing it, talk to your provider about managing any underlying causes. They can help you understand your treatment options and what to expect in your specific situation.
Last reviewed by a Cleveland Clinic medical professional on 03/15/2023.
References
- Baron RM, Massaro AF. Approach to the Patient with Critical Illness. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J, eds. Harrison’s Principles of Internal Medicine. 21st ed. McGraw Hill; 2022.
- Kempker JA, Abril MK, Chen Y, Kramer MR, Waller LA, Martin GS. The Epidemiology of Respiratory Failure in the United States 2002-2017: A Serial Cross-Sectional Study. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314331/) Crit Care Explor. 2020 Jun 10;2(6):e0128. Accessed 3/15/2023.
- Lamba TS, Sharara RS, Singh AC, Balaan M. Pathophysiology and Classification of Respiratory Failure. (https://pubmed.ncbi.nlm.nih.gov/26919670/) Crit Care Nurs Q. 2016 Apr-Jun;39(2):85-93. Accessed 3/15/2023.
- Matthay MA, Zemans RL, Zimmerman GA, et al. Acute respiratory distress syndrome. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709677/) Nat Rev Dis Primers. 2019 Mar 14;5(1):18. Accessed 3/15/2023.
- Vo P, Kharasch VS. Respiratory failure. (https://pubmed.ncbi.nlm.nih.gov/25361907/) Pediatr Rev. 2014 Nov;35(11):476-84; quiz 485-6. Accessed 3/15/2023.
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