Respiratory Failure

When your lungs do not function well enough to perform everyday tasks and sustain your normal activities, you have some degree of respiratory failure. Respiratory failure is complex condition because there are many reasons the lungs cannot adequately move oxygen into blood and remove carbon dioxide from the blood (known as gas exchange). Identifying the reason and getting appropriate therapy or respiratory rehabilitation are essential to improving breathing and quality of life.
 
A person living with chronic respiratory failure may be fearful, anxious, depressed or stressed out by the inability to get enough air or by limitations on the ordinary activities of living.

If you see a person with difficulty breathing who may have acute respiratory failure (also called acute respiratory distress), call 911 immediately. There are many reasons for this emergency ranging from uncontrolled asthma and to obstruction of the airway with food or other material (choking). At Houston Methodist, our highly skilled pulmonologists and health care team work with patients to screen, diagnose and determine the best course of treatment for respiratory failure.

Causes of Respiratory Failure
If your lungs are not getting enough oxygen or they are getting too much carbon dioxide in the blood for any reason, this is respiratory failure. Impaired breathing can cause either by affecting the muscles, nerves, bones or tissues that support breathing or by affecting the lungs directly, according to the National Heart, Lung, and Blood Institute.
 
The following are conditions that can impair the air supply to the lungs:

• A neuromuscular disease, such as muscular dystrophy or amyotrophic lateral sclerosis (ALS)
• Chest injury from broken ribs or a result from an internal injury
• Drug or alcohol overdose

Other diseases or disorders can directly impair gas exchange in the lungs, including:

• Lung diseases and conditions, such as chronic obstructive pulmonary disease (COPD) or cystic fibrosis (CF)
• Acute lung injuries (inhaling harmful fumes or smoke)

Carbon monoxide, which can be from an unvented furnace or a cigarette, blocks the uptake of oxygen by hemoglobin in the blood, which makes gas exchange less efficient.
 
Symptoms of Respiratory Failure
The signs and symptoms of respiratory failure depend on the levels of oxygen and carbon dioxide in the blood.

• A low oxygen level in the blood (hypoxemia) will result in the following:
  • Shortness of breath
  • Air hunger (feeling like you can't breathe in enough air)
  • A bluish color on the skin, lips, and fingernails (if the level of oxygen is very low)
• A high carbon dioxide level (hypercapnia) may cause the following:
  • Rapid breathing (panting)
  • Confusion

If your brain is not getting enough oxygen, you may become sleepy or lose consciousness. Your heart may start beating irregularly and inefficiently if the heart muscle does not get adequate oxygen.
 
Diagnosing Respiratory Failure
Labored breathing and signs of oxygen deprivation, including response to supplemental oxygen, are among the clinical signs and symptoms of chronic respiratory failure.
 
The severity of acute or chronic respiratory failure is determined by checking the oxygen and carbon dioxide levels in your blood. This is done in several ways:

• Pulse oximetry is a small sensor attached to a finger or ear and measures the oxygen level in your blood
• Arterial blood gas test is done through a blood sample taken from an artery where laboratory results determine both the oxygen and carbon dioxide levels in your blood
• A chest X-ray may help find the underlying cause of respiratory failure; an electrocardiogram (EKG), which detects and records the heart's electrical activity, may reveal any effects of respiratory failure on your heart

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Treating Respiratory Failure
While the first goal of treating respiratory failure is to get oxygen to your lungs and other organs and remove carbon dioxide from your body, it is vital to identify and treat the underlying cause.
 
Treatment for respiratory failure depends on whether the condition is acute (short-term) or chronic (ongoing) in its severity. Treatment also depends on the underlying cause.

• Acute respiratory failure can be a medical emergency, often treated in an intensive care unit at a hospital with intubation and mechanical ventilation. A tracheostomy, a surgically made hole that goes through the front of your neck and into your windpipe, may be necessary.
• Chronic respiratory failure often can be treated at home but if chronic respiratory failure is severe, treatment in a long-term care center may be needed. Extra oxygen is given in various ways:
  • Through a nasal cannula (two small plastic tubes, or prongs, that are placed in both nostrils)
  • Through a mask that fits over your nose and mouth
  • By noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep; you wear a mask or other device that fits over your nose or your nose and mouth connected to a machine that blows air into the tube
  • CPAP (continuous positive airway pressure) is one type of NPPV

Oxygen therapy and other treatments can help you breathe easier, but your oxygen and carbon dioxide levels still may not be normal. You may still experience one or more of the following symptoms to some extent:

• Shortness of breath
• Rapid breathing
• Tiredness
• Confusion

Oxygen therapy can be adjusted to minimize your respiratory problems and maximize your quality of life. Pulmonary rehabilitation can help you live with respiratory failure through exercises, education and counseling.