• Respiratory Failure

    (Acute Respiratory Failure; Chronic Respiratory Failure)

    Definition

    Respiratory failure is a problem getting oxygen into the blood and moving carbon dioxide out of the blood. Oxygen is needed for the body to work well, especially active organs like the heart and brain. Carbon dioxide is a waste product made in the body that needs to be passed out of the body through the lungs. Respiratory failure may be:
    • Hypoxemic respiratory failure–low levels of oxygen in the blood
    • Hypercapnic respiratory failure–high levels of carbon dioxide in the blood
    • Combination of low oxygen levels and high carbon dioxide levels
    Acute respiratory failure develops quickly and is often the result of in injury or illness. It may resolve once the injury or infection has cleared.
    Chronic respiratory failure develops slowly over time and is often the result of respiratory illness. This type of failure may require lifelong support.
    Oxygen Exchange in the Lungs
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Normal breathing draws oxygen deep into the lungs and pushes carbon dioxide out. This movement pulls oxygen into small sacs at the tips of the lungs. The sacs are lined with several small blood vessels. This allows oxygen to pass from the small sacs to the blood and allows carbon dioxide to move from the blood to the lungs. An interruption in any part of this process can lead to respiratory failure.
    Interruptions may be caused by 1 or more of the following:
      Problems breathing which may be associated with:
      • Lung disease or conditions that make it difficult for air to move into the lungs
      • Blockage of airway not allowing air movement
      • Injuries to the chest or ribs
      • Muscles or nerves that are not working as expected
      • Structural problems with the spine, such as scoliosis, that make it difficult to fully expand the chest
      Damage to the lung tissue or blood vessels that make it difficult for gases to move from lungs to blood. May be caused by:
      • Trauma or illness
      • Air sacs that are blocked by fluids, harmful fumes or smoke
      • Suppression of breathing from brain damage, stroke, or drug or alcohol overdose

    Risk Factors

    Chronic respiratory failure is most often associated with chronic conditions or diseases such as:
    Acute respiratory failure is often caused by trauma to lungs, chest, or brain which may occur with:
    • Inhaling smoke
    • Blow to chest and ribs
    • Drug or alcohol abuse
    • Stroke
    • Severe head injury
    • Choking
    • Drowning
    • Collapsed lung
    • Trauma or sudden illnesses can also cause a fluid buildup in the lungs called acute respiratory distress syndrome (ARDS). ARDS can lead to acute respiratory failure.

    Symptoms

    Symptoms may vary based on the underlying condition. Acute respiratory failure can start suddenly and be severe. Chronic respiratory failure can develop slowly over time.
    Low oxygen levels can cause:
    • Shortness of breath
    • Feeling like you’re out of breath
    • Bluish color on the skin, lips, and fingernails
    • Loss of consciousness
    • Irregular heartbeats
    A buildup of carbon dioxide in the blood can cause:
    • Rapid breathing
    • Confusion

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will also be done to look for signs of respiratory distress such as bluish skin or rapid breathing. Your doctor will listen for any abnormal sounds during breathing.
    Oxygen and carbon dioxide levels in the blood can be measured by:
    • Blood tests
    • Oximetry—small clip on your finger that uses a light to measure oxygen in the blood
    Your doctor may also need images of the chest and lungs to look for potential causes or injuries.

    Treatment

    Respiratory failure needs to be treated to make sure you have a safe balance of oxygen and carbon dioxide in the blood. Treatment will be based on the severity of the failure and your overall health.

    Acute Failure

    Acute respiratory failure is often treated in a hospital with intensive care. Treatment is focused on increasing the oxygen levels in the blood with oxygen therapy or ventilation.
    Oxygen therapy is oxygen gas that is delivered through a mask or a tube just under the nose. Higher amounts of oxygen in the air you breathe will improve the amount of oxygen in the blood.
    Mechanical ventilation can take over or support your breathing until you are able to breathe on your own again. The machine delivers air to your lungs through a tube placed down the throat or through a breathing tube placed through the neck, called a tracheostomy.
    Other supportive care such as medications and fluids may be given to support you, treat the underlying cause, and decrease discomfort. The respiratory failure often resolves after you recover from the injury or illness causing the problem.

    Chronic Respiratory Failure

    Chronic failure will require long term, often daily care that can be delivered at home. Treatment is focused on maintaining adequate levels of oxygen in the blood. It may be done with oxygen therapy and support during sleep.
    Oxygen therapy is delivered through a mask or tube under the nose. The oxygen may be delivered through a home oxygen unit or with portable tanks. The portable tanks can allow you to move outside the home with your oxygen support for a certain period of time.
    Breathing difficulties can be disruptive during sleep. A special type of ventilation can be used at home during sleep. This machine uses a mask to deliver gentle pressure into the airways. It helps keep the airways open to increase the amount of air in the lungs. Certain sleep positions or specialized beds may also make breathing less difficult. Talk to your doctor or therapists about options that may help.
    Ventilation with a breathing tube or tracheostomy may be needed for some who are unable to breathe on their own.

    Prevention

    There are no preventive steps for respiratory failure due to trauma from an accident.
    If you have a chronic lung disease, work with your doctor to manage your illness and decrease chance of complications. Some steps that may help include:
    • If you smoke, talk to your doctor about ways to quit smoking.
    • Get recommended vaccinations such as pneumonia and flu vaccines
    • Follow care steps if you do get a respiratory illness.

    RESOURCES

    American Lung Association http://www.lung.org

    Centers for Disease Control and Prevention http://www.cdc.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Lung Association http://www.lung.ca

    References

    Explore respiratory failure. National Heart, Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/rf. Updated December 19, 2011. Accessed February 19, 2016.

    Overview of respiratory failure. The Merck Manual Professional Edition. Available at: http://www.merckmanuals.com/professional/critical%5Fcare%5Fmedicine/respiratory%5Ffailure%5Fand%5Fmechanical%5Fventilation/overview%5Fof%5Frespiratory%5Ffailure.html. Updated November 2013. Accessed February 19, 2016.

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