Medically reviewed by Fred Aleskerov, MD — Written by Alana Biggers, M.D., MPH — Updated on April 19, 2022
When a person has acute respiratory failure, the usual exchange between oxygen and carbon dioxide (CO2) in the lungs does not occur. As a result, the heart, the brain, or the rest of the body cannot get sufficient amounts of oxygen.
Acute respiratory failure occurs when the air sacs of the lungs cannot release enough oxygen into the blood. This can be due to fluid buildup, hardening of the air sac walls, asthma-induced muscle spasms, and many other conditions that affect lung function.
Respiratory failure can cause symptoms such as shortness of breath, a bluish tint in the lips and face, and confusion. If a person thinks they or someone else has it, they should seek immediate medical attention.
In this article, we detail the types of acute respiratory failure, their causes, symptoms, and treatments.
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Doctors typically classify acute respiratory failure as one of two types: hypoxemic or hypercapnic.
Hypoxemic respiratory failure
In this type of the condition, there is not enough oxygen in a person’s blood. This is due to a failure in oxygen exchange in the lungs, which can result from swelling of the lungs or fluid buildup.
A person experiencing this will still have stable CO2 levels in their blood.
Hypercapnic respiratory failure
A person with hypercapnic respiratory failure will have higher levels of CO2 in their blood. Their blood oxygen levels may remain steady or be lower than usual.
Hypercapnic respiratory failure occurs when the lungs’ alveoli, or air sacs, cannot adequately excrete CO2 that the body produces.
Acute vs. chronic
Respiratory failure can be acute or chronic. Acute respiratory failure will occur suddenly and require immediate medical attention. This may be due to direct injury or rapid changes in lung function.
By contrast, chronic respiratory failure is an ongoing condition that develops over time and will typically require long-term treatment.
The above conditions and events can increase a person’s risk of acute respiratory failure.
Moreover, babies born prematurely with underdeveloped lungs have a higher risk of acute respiratory failure due to pulmonary hypertension and neonatal respiratory distress.
Older adults may also be more likely to experience acute respiratory failure due to an increased susceptibility to infection and a weakening of the lung muscles.
Other risk factors for acute respiratory failure include:
- recreational alcohol or drug use, which can increase the risk of overdose
- exposure to irritant chemicals, such as in the workplace
- severe allergies
To diagnose acute respiratory failure, a doctor will consider a person’s symptoms and often order a range of tests.
These tests may include:
By assessing the gas levels in a person’s blood, a doctor will be able to determine whether acute respiratory failure is hypoxemic or hypercapnic.
Imaging tests will allow them to check for physical obstructions in the lungs, such as:
- swelling
- cancerous growths
- fluid buildups
A doctor may order additional tests to rule out other potential causes of shortness of breath. These tests may include:
Acute respiratory failure can lead to a range of complications, some of which can be fatal. These include:
- permanent damage or scarring to the lungs
- infections, such as sepsis
- heart damage
- neurological complications from a lack of oxygen
- kidney damage
Treatments for acute respiratory failure depend on the underlying cause. However, most people with acute respiratory failure are likely to require extra oxygen as an initial course of treatment.
Doctors typically use this method of delivering oxygen until they can slow down the progression of, resolve, or reverse the underlying cause of respiratory failure.
In the short term, an individual may also require:
A doctor may also prescribe medications to sedate a person, making breathing with the ventilator easier to tolerate.
Not all causes of acute respiratory failure, such as trauma, are preventable.
However, in the case of pneumonia and some other airway-related conditions, a person can take some steps to protect their lungs.
These include:
If an individual has a history of lung problems and hospitalization, they should discuss with a doctor strategies to enhance their overall health.
Learn more about how to support lung health here.
Acute respiratory failure is a serious medical condition that has many possible underlying causes.
Symptoms include confusion, rapid breathing, and shortness of breath.
Seek immediate medical attention at the first signs of respiratory failure to prevent the condition from worsening.
Last medically reviewed on April 19, 2022
ARDS is a serious condition that can be frightening for patients and their loved ones. The outcomes tend to be better in younger patients, trauma patients and when ARDS is caused by blood transfusions. Chances of survival and recovery are better for those who recover before other organs begin to fail. Liver failure, kidney failure and severely decreased blood pressure are some common warning signs of a potentially life-threatening situation. Survivors can recover full or partial lung function due to scarring. Health problems outside of the lung such as muscle weakness or fatigue can persist for as long as a year.
How Is ARDS Treated?
There is no cure for ARDS at this time. Treatment focuses on supporting the patient while the lungs heal. The goal of supportive care is getting enough oxygen into the blood and delivered to your body to prevent damage and removing the injury that caused ARDS to develop.
Ventilator support
All patients with ARDS will require extra oxygen. Oxygen alone is usually not enough, and high levels of oxygen can also injure the lung. A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. The ventilator is connected to the patient through a mask on the face or a tube inserted into the windpipe.
Prone positioning
ARDS patients are typically in bed on their back. When oxygen and ventilator therapies are at high levels and blood oxygen is still low, ARDS patients are sometimes turned over on their stomach to get more oxygen into the blood. This is called proning and may help improve oxygen levels in the blood for a while. It is a complicated task and some patients are too sick for this treatment.
Sedation and medications to prevent movement
To relieve shortness of breath and prevent agitation, the ARDS patient usually needs sedation. Sometimes added medications called paralytics are needed up front to help the patient adjust to the ventilator. These medications have significant side effects and their risks and benefits must be continuously monitored.
Fluid management
Doctors may give ARDS patients a medication called a diuretic to increase urination in hopes of removing excess fluid from the body to help prevent fluid from building up in the lungs. This must be done carefully, because too much fluid removal can lower blood pressure and lead to kidney problems.
Extracorporeal membrane oxygenation (ECMO)
ECMO is a very complicated treatment that takes blood outside of your body and pumps it through a membrane that adds oxygen, removes carbon dioxide and then returns the blood to your body. This is a high-risk therapy with many potential complications. It is not suitable for every ARDS patient.
Recovering from ARDS
ARDS patients may require ventilation for long periods of time. On average this is seven to 14 days. Beyond this time, doctors may suggest a tube be placed directly into the windpipe through the neck (tracheostomy) by a surgeon. Usually the doctor believes it may take weeks more to recover from ventilator support. This tube can easily be removed once the patient is free of the need for a ventilator. It is important to note that most people survive ARDS. They will not require oxygen on a long-term basis and will regain most of their lung function. Others will struggle with muscle weakness and may require re-hospitalization or pulmonary rehabilitation to regain their strength.
For More Information:
- Consult the ARDS Foundation
Medically Reviewed by Paul Boyce, MD on January 31, 2021
Respiratory failure is a condition in which your lungs have a hard time loading your blood with oxygen or removing carbon dioxide. It can leave you with low oxygen, high carbon dioxide, or both. If you aren’t getting enough oxygen into your blood, your doctor will call this hypoxemic or type 1 respiratory failure. If you have too much carbon dioxide, it’s called hypercapnic, hypercarbic, or type 2 respiratory failure. Acute respiratory failure comes on quickly, and it's an emergency. But respiratory failure can also be chronic, a long-term problem that you'll need regular care to manage. Breathing may seem like a simple act, but there are a lot of moving parts. A problem with any one of them can lead to respiratory failure, including: Acute respiratory failure is more common with an injury to your brain, chest, or lungs. Things like choking, drowning, or getting hit in the chest could all do it. A sudden, serious illness that affects breathing, like acute respiratory distress syndrome (ARDS), can also bring it on. You might have a higher risk of respiratory failure if you: Your symptoms will depend on the cause and whether you have low oxygen, high carbon dioxide, or both. Some things you may notice are:
- Bluish color to your fingernails, lips, and skin
- Feeling that you just can't take in enough air
- Confusion
- Heartbeat that's off
- Rapid breathing or extremely slow breathing
- Shortness of breath
- Sleepiness or passing out
You'll start with a physical exam and questions about your health. You'll then get one or both of these tests: Pulse oximetry. Your doctor puts a small device on your finger or ear to measure your oxygen level. Arterial blood gas test. This basic blood test measures your levels of oxygen and carbon dioxide. You may need more tests to look for the cause. That might include things like a chest X-ray or an EKG, which measures electrical signals in your heart. Your treatment might include: Oxygen therapy. You breathe in oxygen, through either a mask or a thin tube with two prongs that sit just inside your nose. You can get a portable oxygen tank so you can still go out and about with it. Ventilator. You might need one of these breathing machines if oxygen therapy isn't enough or if you can't breathe on your own. They blow air into your lungs so you get the oxygen you need without having to work so hard for it. They also help lower carbon dioxide levels. There are a few types. With smaller, simpler ones, you wear a mask over your nose or mouth. A CPAP machine, used for sleep apnea, is one example. For a more severe problem, you might need a breathing tube that goes down your throat. Tracheostomy. This is surgery in which your doctor makes an opening in your neck and windpipe to put in a small tube. It's called a trach tube and can make breathing easier. You may also get this if you'll need a ventilator for more than a week or two. The ventilator connects directly to the trach tube. Treating the cause. You might need care for the condition that caused your respiratory failure, too. That could mean things like: Your treatment will depend on the cause and whether your respiratory failure is chronic or acute. Acute and chronic cases aren’t treated the same way, but the ideas are similar:
Acute. You'll go to an ER, but if your treatment there doesn't solve the problem, you may need to stay overnight in the hospital. For severe symptoms, you may need to go to the intensive care unit (ICU). You may get oxygen therapy. And you may need a ventilator until you can breathe on your own. You'll also get medicine and fluids to ease your symptoms and treat the cause of your respiratory failure. Chronic. You’ll get ongoing care in your home, which typically includes medication you take every day -- either inhaled medicine or drugs you take by mouth. In severe cases, you might need oxygen therapy. Because respiratory failure can make it harder for you to sleep, you may also need extra help at night. That could mean one of the smaller ventilators, like a CPAP machine, to get more air into your lungs. Or you may need a special bed that rocks back and forth to help you breathe better. For more serious cases, you'll need a ventilator. If you have acute respiratory failure, treatment right away can help get you back to your normal activities. With chronic respiratory failure, it’s important to follow your doctor’s advice about ongoing care. Know what your symptoms mean and when you might need to call your doctor. Respiratory failure is serious, but many things can affect how you do, including what’s causing your condition.