Respiratory Failure - Causes, Symptoms, Diagnosis, and Treatment

What Is Respiratory Failure?

Respiratory failure is a pathological condition where a person's blood does not have an adequate amount of oxygen, or on the other hand, it has increased levels of carbon dioxide. Sometimes a person can have both problems. Blood is responsible for carrying oxygen into the person's organs. When a person breathes, 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 any major life-threatening problem. Another function of breathing is removing carbon dioxide from the blood carried away from the organs and breathing it out. Having an excess amount of carbon dioxide in the blood can harm a person's organs and leads to suffocation.

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 in breathing. It might also affect the lungs directly by 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 supports breathing, like amyotrophic lateral sclerosis, muscular dystrophies, spinal cord injuries naturally or by trauma, and stroke.

• Problems in the structure of the spine, such as scoliosis where the vertebral column is curved in shape that resembles the alphabet "S." They 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 at the chest region might cause this damage.

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• Drug or alcohol abuse.

• Inhalation injuries that 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 concerned etiology and the levels of oxygen and carbon dioxide 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 feel that they are unable to inhale an adequate amount of air. An increase in 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 also may experience arrhythmia, which is an irregular heartbeat pattern. The affected person might have all the above-said symptoms if their brains and hearts are not adequately getting enough oxygen.

How Is Respiratory Failure Diagnosed?

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

• Focussed and thorough medical history of the patient.

A physical examination that often includes the following-

• Listening to a person's lungs to look for the presence of abnormal sounds.

• Listening to the person's heart to look out for abnormal rhythm 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 a 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 to measure the oxygen and carbon dioxide levels in the person's blood. In this process, a person's blood sample is collected from an artery, most commonly from the wrist of the individual.

Once a person is diagnosed with respiratory failure, the health care 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 health care provider doubts that the person might have arrhythmia due to respiratory failure, they might check your heart rhythm pattern through an EKG. This is a very simple, painless diagnostic tool that helps detect and record the affected person's heart's electrical activity.

What Is the Goal of the Treatment?

One of the chief goals in treating respiratory failure is to increase oxygen supply mainly to the affected person's lungs and the other organs and to remove carbon dioxide from the person's body. The secondary goal is to treat the actual cause that leads to this condition.

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 intensive care unit at a hospital for days to even 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.

What Are the Types of Treatment?

• Oxygen therapy increases oxygen saturation levels, the most primary and life-saving measure in respiratory failure patients.

• Tracheostomy, especially in an emergency condition.

• Mechanical ventilator support will be needed in severe as well as acute conditions.

• Fluid replacement.

• Medicines for symptomatic relief and the treatment of the underlying pathology.

How Is the Prognosis?

The mortality rate related to respiratory failure differs based on the etiology. In the case of acute respiratory distress syndrome, the mortality rate is approximately 40 to 45%. Younger patients less than 60 years of age have a better prognosis than older patients. Mortality also occurs in these patients admitted with a chief complaint of hypercapnic respiratory failure. This is due to underlying chronic respiratory disease and other co-morbidities like cardiopulmonary, kidney-related, hepatic, or neurologic disease. These patients are also noted to have a poor nutritional status.

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