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Respiratory Failure - Causes, Symptoms, Diagnosis, and Treatment

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Respiratory Failure - Causes, Symptoms, Diagnosis, and Treatment

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A loss of respiratory system functioning can result in respiratory failure in severe conditions. Please read this article to learn more.

Written by

Dr. Lochana .k

Medically reviewed by

Dr. Rahul Reddy Keesari

Published At March 3, 2022
Reviewed AtMay 6, 2024

What Is Respiratory Failure?

Respiratory failure is a pathological condition in which a person's blood does not have an adequate amount of oxygen or, on the other hand, has increased levels of carbon dioxide. Sometimes, a person can have both problems. Blood is responsible for carrying oxygen into a person's organs. When people breathe, their lungs take oxygen through the air passages, namely the trachea and the bronchus. The oxygen diffuses into the person's blood.

Organs, especially vital organs like the heart and brain, need oxygen-rich blood to work properly without causing major life-threatening problems. Another function of breathing is removing carbon dioxide from the blood carried away from the organs and breathing it out. An excess amount of carbon dioxide in the blood can harm a person's organs and lead to suffocation.

What Types of Respiratory Failure Exist?

Respiratory failure may manifest suddenly as acute or gradually over time as chronic. Two prevalent classifications are hypoxemic respiratory failure (type 1) and hypercapnic respiratory failure (type 2). Additional categories encompass perioperative respiratory failure (type 3), linked to surgery, and respiratory failure attributed to shock (type 4).

Hypoxemic Respiratory Failure

Hypoxemic respiratory failure occurs due to inadequate oxygen levels in the bloodstream (hypoxemia), often stemming from heart or lung conditions. It is alternatively referred to as hypoxic respiratory failure.

Hypercapnic Respiratory Failure

Hypercapnic respiratory failure occurs when there is an excess of carbon dioxide (CO2) in the bloodstream. If the body fails to eliminate this waste product, it impairs the capacity of blood cells to transport oxygen effectively. Common triggers include heart, lung, muscle, neurological conditions, and certain medications. It is also known as hypercarbia respiratory failure.

Perioperative Respiratory Failure

Perioperative respiratory failure may occur during surgery, often due to anesthesia hindering proper breathing. In some cases, lung air sacs can collapse (atelectasis), impeding the entry of oxygen into the bloodstream.

Respiratory Failure Stemming From Shock

Shock, characterized by low blood pressure, pulmonary edema (fluid in the lungs), and related complications, can precipitate respiratory failure. Shock can arise from conditions such as sepsis, cardiac events (e.g., heart attacks), and blood loss.

What Are the Causes of Respiratory Failure?

Any pathological condition that affects the breathing of an individual can lead to respiratory failure. These conditions might indirectly affect the muscles, nerves, bones, or tissues that aid breathing. It might also directly affect the lungs through any disease process or pathology. These conditions include the following:

  • Lung disorders such as cystic fibrosis, obstructive pulmonary disease, pneumonia of varied etiology, and pulmonary embolism.

  • Conditions that cause damage to the nerves and muscles that control breathing and support breathing, like amyotrophic lateral sclerosis, muscular dystrophies, spinal cord injuries naturally or by trauma, and stroke.

  • Problems in the spine's structure, such as scoliosis, where the vertebral column is curved in a shape that resembles the alphabet S," can affect the normal supportive function of the bones and muscles used for breathing.

  • Damage to the muscles and ribs around the lungs. An injury in the chest region might cause this damage.

  • Drug or alcohol abuse.

  • Inhalation injuries can be caused by inhaling the smoke from a fire incident or harmful fumes.

What Are the Symptoms of Respiratory Failure?

The symptoms of respiratory failure occur based on the etiology and the oxygen and carbon dioxide levels in the affected person's blood. A decrease in oxygen levels in the blood can lead to shortness of breath and air hunger, affecting individuals who cannot inhale enough air. Increased carbon dioxide levels can lead to rapid and forceful breathing and confusion. The person's skin, oral cavity, tongue, lips, and fingernails might present with a bluish color change called cyanosis. Some people affected by respiratory failure might experience extreme sleepiness or lose consciousness. They may also experience arrhythmia, which is an irregular heartbeat pattern. The affected person might have the above symptoms if their brains and hearts are not adequately getting enough oxygen.

What Are the Risk Factors for Respiratory Failure?

Risk factors contributing to respiratory failure encompass:

  • Lung-related ailments include acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), pneumonia, asthma, cystic fibrosis, pulmonary edema, pulmonary embolism, and pulmonary fibrosis.
  • Heart or circulatory disorders, including heart attacks, congenital heart diseases, heart failure, and shock.
  • Afflictions affecting the nerves and muscles crucial for breathing, like muscular dystrophy, amyotrophic lateral sclerosis (ALS), severe scoliosis, and Guillain-Barré syndrome.
  • Injuries to the chest, spinal cord, or brain, including strokes.
  • Smoking or exposure to lung irritants like chemical fumes, dust, air pollution, and asbestos.
  • Surgical procedures necessitate sedation or anesthesia.
  • Substance abuse or excessive alcohol consumption.
  • Age, with newborns (especially premature infants) and individuals over 65 being at heightened risk of respiratory failure.

How Is Respiratory Failure Diagnosed?

Doctors will diagnose respiratory failure using the following tools in a hospital setting.

  • Focused and thorough medical history of the patient.

A physical examination often includes the following-

  • Listening to a person's lungs to look for abnormal sounds.
  • Listening to the person's heart to look out for abnormal rhythms in the person's heartbeat.
  • Look for discoloration on the person's skin, lips, tongue, buccal mucosa, and fingernails.

Diagnostic tests include the following:

  • Pulse oximetry is a small sensor machine that uses light to measure the oxygen saturation levels in a person's blood. The sensor is frequently fitted on the end of the person's index finger or, rarely, on the ear.
  • Arterial blood gas measurement is a test that helps measure the oxygen and carbon dioxide levels in a person's blood. In this process, a blood sample is collected from an artery, most commonly from the wrist.
  • Once a person is diagnosed with respiratory failure, the healthcare provider will check for the disease's etiology in a very focused manner. Tests at this stage often include a chest x-ray in the anterior-posterior direction. If the healthcare provider doubts that the person might have arrhythmia due to respiratory failure, they might check the heart rhythm pattern through an EKG. This simple, painless diagnostic tool helps detect and record the affected person's heart's electrical activity.

What Are the Treatment Options?

Treatment of respiratory failure primarily focuses on:

  • Whether the respiratory failure is acute or chronic at the onset.

  • The severity of the respiratory failure.

  • The underlying etiology of respiratory failure.

  • Severe cases of respiratory failure are a medical emergency. The affected person will need treatment in the hospital intensive care unit for days to months. Chronic respiratory failure can mostly be treated at home. But if there is a sudden and severe flare-up in a person's chronic respiratory failure, they might need immediate treatment in long-term care.

Conclusion

Respiratory failure, stemming from various lung, heart, neurological, and traumatic conditions, presents a critical medical challenge. Factors such as smoking, substance abuse, and age further compound the risk. Awareness of these factors is paramount to preventing and managing respiratory failure, highlighting the importance of tailored interventions and vigilant monitoring in high-risk populations.

Frequently Asked Questions

1.

Can Respiratory Failure Be Treated?

Yes, the treatment options are as follows:
- The most important and life-saving intervention for individuals with respiratory failure is oxygen treatment, which elevates oxygen saturation levels.
- Tracheostomy, especially when there is an emergency.
- Serious cases require mechanical ventilator support.
- Severe respiratory failure is considered a medical emergency. The affected person will require care in a hospital's critical care unit for days or possibly months. Most of the time, chronic respiratory failure may be treated at home. However, if a person's chronic respiratory failure flares up suddenly and severely, they might require quick treatment in long-term care.
- Administration of drugs that address both the underlying pathology and the symptoms.

2.

Is it possible for Someone to Recover From Respiratory Failure?

Yes, it is possible that individuals having respiratory failure recover if provided the proper and adequate treatment at times, especially during emergency cases. Also, prompt treatment may prevent further complications associated with respiratory failure.

3.

Does Respiratory Failure Mean Death?

Respiratory failure is of two types acute and chronic. Acute types occur suddenly. It happens because of a condition or injury that impairs the lungs' capacity to expel carbon dioxide or provide oxygen. Most of the time, acute respiratory failure can be fatal if it is not treated right away. However, the chronic type may happen if the airways get constricted or harmed over time. It can also happen in cases when the respiratory muscles gradually become weaker. 

4.

Is Respiratory Failure a Serious Condition?

Yes, respiratory failure should not be taken lightly as it affects individual breathing. Respiratory failure is a serious illness that makes breathing difficult on its own. Respiratory failure happens when the lungs are unable to provide the blood with enough oxygen. 

5.

Can Someone Survive Respiratory Failure?

Respiratory failure mortality rates vary depending on the underlying cause. The death rate for acute respiratory distress syndrome ranges from 40 to 45v%. People under the age of 60 have a better prognosis than patients above the age of 60. When these individuals present with hypercapnic respiratory failure as their primary complaint, mortality also increases. This is attributed to underlying chronic respiratory disease and associated co-morbidities such as cardiovascular, kidney-related, hepatic, or neurologic disease.

6.

What Is the Treatment of Acute Respiratory Failure?

Acute respiratory failure may be a medical emergency that requires intubation and artificial ventilation at a hospital's intensive care unit. A tracheostomy, in which an incision is made in the front of the neck and leads directly into the windpipe, may be necessary.

7.

Is Respiratory Failure the Same as Heart Failure?

Respiratory failure and heart failure are linked. Acute respiratory failure (ARF) is a frequent occurrence in emergency rooms in patients over 65 and is one of the main indicators of congestive heart failure (CHF) and respiratory conditions.

8.

What Medications are Required In Treating Respiratory Failure?

Medications are required to treat the cause that has caused the respiratory failure. These medications include antibiotics which can treat bacterial lung infections like pneumonia; corticosteroids which can reduce inflammation; and bronchodilators to open or dilate the airways.

9.

What Are the Symptoms of Respiratory Failure?

A reduction in blood oxygen levels can cause shortness of breath and air hunger, affecting individuals who feel they are unable to inhale enough air. Increased quantities of carbon dioxide can cause confusion and strong, fast breathing. The person may exhibit cyanosis, a bluish color shift, on their skin, tongue, lips, and fingernails. Respiratory failure can cause some people to become extremely sleepy or lose consciousness. They can also endure an abnormal cardiac pattern known as arrhythmia. If the brain and heart are not receiving enough oxygen, the patient may exhibit all of the symptoms listed above.

10.

How Is Respiratory Failure Diagnosed?

Clinical symptoms, physical examination findings, and laboratory tests all contribute to a diagnosis of acute respiratory failure. The diagnostic tests include:
- A sensor device called a pulse oximeter utilizes light to gauge a person's blood oxygen saturation levels. The sensor is commonly attached to a person's index finger or, less frequently, to their ear.
- An examination known as an arterial blood gas measurement is used to gauge a person's blood levels of oxygen and carbon dioxide. A person's blood is drawn from an artery during this procedure, most frequently from the wrist.

11.

Can Respiratory Failure Result In Memory Loss?

Yes, it is possible that respiratory failure may lead to memory loss because of the low levels of oxygen in the blood. Studies have shown an association between dementia (memory loss) and respiratory failure.

12.

How Does Respiratory Failure Affect In The Long Run?

Long-term consequences include a noticeably increased chance of problems, such as lung damage or injury to muscles and nerves, that can cause pain and weakness. Depression and post-traumatic stress disorder (PTSD) might appear in the affected individuals.

13.

How Much Oxygen Should a Person Have While Sleeping?

The blood oxygen level should typically be between 95 % and 100 % if an individual is obtaining enough oxygen throughout the day. The term for this is oxygen saturation. However, 90 % is seen as normal during sleep because the respiratory rate slows down as people sleep.
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Dr. Rahul Reddy Keesari
Dr. Rahul Reddy Keesari

Pulmonology (Asthma Doctors)

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