HomeHealth articlesrespiratory healthHow Can We Manage Respiratory Failure?

Types of Respiratory Failure - Causes, Symptoms, Diagnosis, and Management

Verified dataVerified data
0

5 min read

Share

Respiratory failure is an emergency medical condition that makes it difficult for one to breathe on their own. Read the article below to know more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At January 3, 2023
Reviewed AtMay 31, 2023

Introduction:

The respiratory system is divided into upper and lower respiratory zones, respectively. The tracheobronchial tree is divided into 23 generations according to Weber's model. From the trachea to the sixteenth terminal, the bronchioles are called the conducting zone or the anatomical dead space where no gaseous exchange occurs. From the seventeenth terminal, bronchioles, to the twenty-third terminal, alveoli are known as the respiratory zone where gaseous exchange occurs.

There are approximately 300 million alveoli present in both lungs. The alveolar cells line the alveoli. Alveolar cells are of two types- type 1 and type 2. Type 1 alveolar cells or pneumocytes occupy 96-98 % of the surface area of alveoli, whereas type 2 alveolar cells or pneumocytes occupy only two to four percent of the surface area of alveoli.

The major function of these two types of alveolar cells is the gaseous exchange and secreting surfactant, respectively. Terminal bronchioles are the seat of resistance in the respiratory system. The major function of the respiratory system is the gaseous exchange between the environment and the body. It specifically provides oxygen and removes carbon dioxide from the body.

The other non-respiratory functions of the respiratory system are: acid-base balance, secreting surfactant, pulmonary circulation, defense mechanism, articulation and phonation, and serotonin metabolism. Respiratory failure can occur if there is an abnormality in any part of the respiratory tract, including the airways, alveoli, respiratory muscles, central nervous system, peripheral nervous system, and chest wall.

What Are the Types of Respiratory Failure?

Respiratory failure is classified based on blood gas analysis as follows:

Type 1: Hypoxemia without hypercapnia caused by a failure of gas exchange due to mismatching of pulmonary ventilation and perfusion. It is characterized by an arterial oxygen pressure (PaO2) of less than 60 mm Hg and a normal or low arterial carbon dioxide pressure (PaCO2). It is the most common type of respiratory failure and can be associated with acute diseases of the lungs.

Type 2: Hypoxemia with hypercapnia due to alveolar hypoventilation, which occurs when the respiratory muscles cannot perform sufficient work to remove the carbon dioxide produced by the body. It is characterized by arterial carbon dioxide pressure (PaCO2) higher than 50 mm Hg. The blood's pH depends on the bicarbonate levels, which in turn is dependent on the duration of hypercapnia.

Depending on their chronicity, respiratory failure may be further classified into acute and chronic.

  • Acute Respiratory Failure: It may develop within minutes to hours and is considered a life-threatening situation with an imbalance in the arterial blood gas and acid-base status.

  • Chronic Respiratory Failure: It may develop over several days or more. This allows the time for renal compensation and an increase in bicarbonate levels.

What Are the Causes of Respiratory Failure?

Common causes of respiratory failure in critically ill patients are:

Type 1 Respiratory Failure:

  • Pneumonia

  • Pulmonary edema

  • Pulmonary embolism.

  • Pulmonary fibrosis.

  • Pneumothorax.

  • Pulmonary contusion or blunt chest trauma.

  • Acute respiratory distress syndrome.

  • Asthma.

  • Aspiration.

  • Lung collapse due to retained secretions.

Type 2 Respiratory Failure:

  • Reduced respiratory drive, for example, drug overdose or head injury.

  • Upper airway obstruction is due to edema, infection, and a foreign body.

  • Late severe acute asthma.

  • Flail chest injury.

  • Chronic obstructive lung disease (COPD).

  • Peripheral neuromuscular diseases such as Guillain-Barre disease and myasthenia gravis.

What Are the Symptoms of Respiratory Failure?

Symptoms of respiratory failure depend upon whether there is inadequate oxygen or excessive carbon dioxide in the blood.

Hypoxemic Symptoms Are:

  • Shortness of breath or dyspnea.

  • Cyanosis or bluish discoloration of the skin and mucous membranes is especially seen in nails, earlobes, and the tongue.

  • Increased heart rate or tachycardia. Occurs as a result of compensatory mechanisms to pump more blood to the oxygen-deprived tissues.

  • Coughing.

  • Severe headache.

  • Pulmonary hypertension.

Hypercapnia Symptoms Are:

  • Increase in the rate of breathing per minute or tachypnea.

  • Confusion or disorientation.

  • Flushed skin.

  • Fatigue and drowsiness.

  • Muscle cramps.

  • Elevated blood pressure.

  • Headache.

Severe Respiratory Failure Symptoms Include:

  • Arrhythmias.

  • Seizures.

  • Fainting.

  • Panic attack.

What Are the Types of Diagnostic Tests That Can Be Carried Out?

Various tests can be carried out to detect respiratory failure, such as:

  • Arterial Blood Gas (ABG) Analysis: It helps to identify the type of respiratory failure. It includes the measurement of arterial oxygen, carbon dioxide, and pH. The calculation can be done with the help of the Henderson-Hasselbach equation, where pH is directly proportional to bicarbonate ions and indirectly proportional to carbon dioxide. The normal partial pressure of carbon dioxide is 35-45mmHg; more than 45mmHg is acidosis, whereas less than 35mmHg is alkalosis. The normal partial pressure of bicarbonate ions ranges between 22-26mmHg, where more than 26 is considered alkalosis and less than 22 is acidosis.

  • Pulse Oximetry: It is a probe that checks the oxygen saturation level of the blood. It is attached to the fingertips of the patient and continuously monitored on the screen.

  • Capnography: It provides a continuous reading of the respiratory system and the end-tidal carbon dioxide.

  • Echocardiogram: It helps monitor cardiac function as tachycardia and arrhythmias may occur due to hypoxemia and acidosis.

  • Imaging: Chest X-ray or computed tomography (CT) scan can help diagnose infections or certain lung conditions.

  • Pulmonary Function Test or Spirometry: It is useful in evaluating chronic respiratory failure.

  • Pulmonary Capillary Wedge Pressure: It helps to differentiate between cardiogenic and noncardiogenic edema.

What Is the Management of Respiratory Failure?

Depending on the patient's clinical presentation, interventions should aim to correct hypoxemia, hypercapnia, and respiratory acidosis. The management does not only focus on the supportive treatment but also the treatment of the underlying cause.

Treatment of Respiratory Failure:

  • Non-Invasive Ventilation (NIV): Is used as an alternative to invasive ventilation. It is generally indicated in chronic obstructive lung diseases (COPD), cardiogenic pulmonary edema, and pulmonary infiltrates in immunocompromised patients. It improves survival chances and reduces complications for patients with acute respiratory failure.

  • Extracorporeal Membrane Oxygenation (ECMO): It is used in critically ill patients, allows the blood to bypass organs such as the heart and lungs, and allows these organs to repair and heal. It is a heart-lung machine that provides oxygen to the tissues in the body and simultaneously removes carbon dioxide from the body.

  • Mechanical Ventilation: Mechanical Ventilation or assisted ventilation is a machine that helps a critically ill patient to breathe when they are unable to do so spontaneously. It is used to protect the airways due to mechanical or neurologic causes, to supply adequate oxygenation, or to remove excess carbon dioxide from the body. Prolonged ventilator use can be harmful, damage the lungs and the airways, and lead to infections such as pneumonia.

  • Tracheostomy: A surgical incision is made on the front of the neck. A thin-walled, narrow-lumen tube is placed into the trachea to help one breathe enough oxygen to balance the carbon dioxide levels.

Medications Used to Treat Respiratory Failure:

  • Bronchodilators: To open up the airways such as short and long-acting beta-agonists.

  • Corticosteroids: To reduce the inflammation of the airways and the lungs.

  • Antibiotics: Depending on bacterial lung infection, such as pneumonia.

Conclusion:

Respiratory failure is an emergency medical condition that makes it difficult to breathe on their own. It can develop when the body cannot provide sufficient oxygen to the organs and tissues. Accumulating carbon dioxide can lead to irreversible organ damage and slow down oxygen delivery to the body. Hence, it is very important to diagnose the condition as early as possible and intervene immediately to avoid irreversible damage and death.

Frequently Asked Questions

1.

How Threatening Is Respiratory Failure?

Respiratory failure is a severe condition that affects the normal breathing process and makes it difficult. It develops when an adequate amount of oxygen is unable to get into the blood from the lungs. Carbon dioxide, a waste gas produced by the cells, is exhaled as oxygen is inhaled into the lungs. 

2.

What Does Respiratory Failure Death Mean?

When the respiratory system cannot remove enough carbon dioxide from the blood, which causes it to build up in the body, respiratory failure can occur. The condition can also occur when the respiratory system is unable to take in sufficient oxygen, resulting in blood oxygen levels that are dangerously low.

3.

How Can Fast Respiratory Failure Occur?

Respiratory failure can be acute or chronic. Acute illness occurs in a matter of minutes or hours. Typically, there is no underlying lung disease in the patient. The chronic illness lasts for days and usually comes from lung disease. Acute or chronic means that someone with chronic respiratory failure experiences a sudden or rapid decline in their ability to breathe.

4.

How Does COVID Result in Respiratory Failure?

More air sacs may become filled with fluid leaking from the lungs' tiny blood vessels if COVID-19 pneumonia progresses. Shortness of breath eventually develops and can result in acute respiratory distress syndrome (ARDS), a type of lung failure. Only a small number of people infected with COVID-19 will pass away due to respiratory failure, which can develop rapidly.

5.

Is It Possible to Recover From Respiratory Failure?

Acute respiratory failure can be a fatal medical emergency. Therefore, it usually requires treatment in intensive care units. Although treating chronic respiratory failure at home is possible, severe cases may necessitate admission to a long-term care facility.

6.

What Is the Recovery Time Following Respiratory Failure?

Most people who survive ARDS regain normal or close to normal lung function within six months to a year. However, other people might not do as well. This is especially true if their illness was brought on by severe damage to their lungs or if their treatment required them to use a ventilator for a long time.

7.

Is Respiratory Failure Fatal?

Acute respiratory failure has a sudden onset. It occurs when a disease or injury affects the ability of the lungs to remove carbon dioxide or deliver oxygen. If not treated quickly, most cases of acute respiratory failure can result in death.

8.

How to Treat Respiratory Failure?

The goal of treatment for respiratory failure is to raise blood oxygen levels and eliminate carbon dioxide waste if they are elevated. Oxygen therapy, medications, and procedures to assist the lungs in resting and recovering are all possible treatments for respiratory failure. Chronic cases of respiratory failure can be treated at home, but long-term care center treatment may be required if it gets serious.

9.

Does Respiratory Failure Recover on Its Own?

Respiratory failure does not resolve on its own. It requires treatment, depending on whether it is acute or chronic. Acute cases are sudden in onset and may require treatment in hospital intensive care units as they are usually medical emergencies. Chronic cases can be treated at home, but they require a long-term care facility if they get serious.

10.

What Effect Does Respiratory Failure Have on the Body?

Respiratory failure can happen slowly. 
The symptoms include the following-
- Extreme exhaustion.
- Inability to exercise normally.
- Drowsiness.
- Shortness of breath.
Source Article IclonSourcesSource Article Arrow
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

Tags:

respiratory health
Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Source Article ArrowMost popular articles

Do you have a question on

respiratory health

Ask a doctor online

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy