Acute respiratory failure requires emergency treatment. Call 9-1-1 if you suddenly experience trouble breathing, feel confused, or if your family or caregivers notice a bluish color on your skin or lips.

Respiratory failure is a serious condition that makes it difficult to breathe on your own. Respiratory failure develops when the lungs can’t get enough oxygen into the blood.

We breathe oxygen from the air into our lungs, and we breathe out carbon dioxide, which is a waste gas made in the body’s cells. Breathing is essential to life itself. Oxygen must pass from our lungs into our blood for our tissues and organs to work properly.

Buildup of carbon dioxide can damage tissues and organs and prevent or slow oxygen delivery to the body.

Acute respiratory failure happens quickly and without much warning. It is often caused by a disease or injury that affects your breathing, such as pneumonia, opioid overdose, stroke, or a lung or spinal cord injury

Respiratory failure can also develop slowly. When it does, it is called chronic respiratory failure. Symptoms include shortness of breath or feeling like you can’t get enough air, extreme tiredness, an inability to exercise as you did before, and sleepiness.

A doctor may diagnose you with respiratory failure based on the oxygen and carbon dioxide levels in your blood, a physical exam to see how fast and shallow your breathing is and how hard you are working to breathe, as well as the results of lung function tests.

If you are diagnosed with a serious lung disease such as respiratory failure, you may need extra oxygen through tubes in your nose or support with a breathing machine called a ventilator.

Age

• Premature babies who have neonatal respiratory distress due to an under-developed lung, pulmonary hypertension, or certain lung birth defects have a higher risk of respiratory failure.
• Older adults have more risk factors for respiratory failure. It is more likely that food will accidentally go down the windpipe instead of the food pipe or that a cold will lead to a severe chest infection. Older adults are also more likely to have muscle weakness that can affect breathing.

Environment or occupation

Breathing in lung irritants can lead to lung damage over the long term and put you at risk of serious lung diseases. You may breathe in these irritants from the air where you live or work. Lung irritants include air pollution, chemical fumes, asbestos, aniline (artificially produced) dyes and paints, dust, and secondhand smoke (smoke in the air from other people smoking).

Other medical conditions

You may have a greater risk of respiratory failure if you have certain medical conditions or injuries, such as the following:

• Nerve and muscle disorders including amyotrophic lateral sclerosis, Guillain-Barre syndrome, and myasthenia gravis
• Lung and airway diseases such as asthma, cystic fibrosis, COPD, and interstitial lung diseases
• Fluid buildup in the lungs or pulmonary embolism (a blood clot in your lungs)
• Infections in your brain or spinal cord (such as meningitisexternal link), lungs (such as pneumonia), or airways (such as bronchiolitis)
• Blocked airway when food or another object gets stuck in your airways
• Chest or back injuries, which may damage your ribs or lungs
• Severe scoliosis, which happens when the spine is curved from side to side
• Severe allergies to food or medicine, which can cause your throat to swell up

Lifestyle habits

• Smoking can cause lung diseases that raise your risk of respiratory failure.
• Using drugs or alcohol raises your risk of an overdose. A drug or alcohol overdose affects the area of the brain that controls breathing. During an overdose, breathing becomes slow and shallow, and which may cause acute respiratory failure. This can happen from using illegal drugs or misusing prescription opioid painkillers.

Medicines or medical procedures

Certain sedatives used during surgery affect your breathing. This can put you at risk of respiratory failure, especially if you have other risk factors. Complications from major surgery can also raise your risk of respiratory failure.

Any condition or injury that affects breathing can cause respiratory failure. The condition or injury may affect your airways or lungs. Or it may affect the muscles, nerves, and bones that help you breathe.

When you can't breathe well, your lungs can’t easily move oxygen into your blood or remove carbon dioxide. This causes a low oxygen or high carbon dioxide level in your blood.

Respiratory failure can be caused by several factors.

• Conditions that make it difficult to breathe in and get air into your lungs: Examples include weakness following a stroke, collapsed airways, and food getting stuck in and blocking your windpipe.
• Conditions that make it difficult for you to breathe out: Asthma causes your airways to narrow, while COPD can cause mucus to build up and narrow your airways. Both can make it hard for you to breathe out.
• Lung collapse: When no air can enter your lungs, your lungs may collapse. This can happen in certain situations, such as when the muscles that you use to breathe become extremely weak, mucus blocks one of the large airways, or a rib is broken or fractured and severe pain makes it difficult to take a deep breath.Chest or lung injury can also cause air to leak from the lung, filling the space around it, which is called a pneumothorax.
• Fluid in your lungs: Thismakes it harder for oxygen to pass from the air sacs into your blood and for carbon dioxide in your blood to pass into the air sacs to be breathed out. Pneumonia, acute respiratory distress syndrome (ARDS), drowning, and other lung diseases can cause this fluid buildup. It can also be caused by heart failure, which is when your heart can’t pump enough blood to the rest of your body. Severe head injury or trauma can also cause sudden fluid buildup in the lungs.
• A problem with your breathing muscles: These problems can occur after a spinal cord injury or when you have a nerve and muscle condition such as muscular dystrophy.This may also happen when your diaphragm and other breathing muscles do not get enough oxygen-rich blood, when the heart is not pumping well enough (cardiogenic shock), or when you get a severe infection called sepsis.
• Conditions that affect the brain’s control over breathing: In opioid overdose, for example, the brain may not detect high levels of carbon dioxide in the blood. Normally, the brain would signal to you to deepen your breathing so that you breathe out the carbon dioxide. Instead, carbon dioxide builds up in the body while oxygen levels fall, leading to respiratory failure.

Symptoms of respiratory failure depend on its cause, the levels of oxygen and carbon dioxide in your blood, and whether respiratory failure developed slowly over time or suddenly. Acute respiratory failure can be a life-threatening emergency.

Low oxygen levels in your blood can cause:

• Difficulty with routine activities such as dressing, taking a shower, and climbing stairs, due to extreme tiredness
• Shortness of breath or feeling like you cannot get enough air (called air hunger)
• Drowsiness
• A bluish color on your fingers, toes, and lips

High carbon dioxide levels in your blood can cause:

• Blurred vision
• Confusion
• Headaches
• Rapid breathing

You can have symptoms of low oxygen and high carbon dioxide at the same time. Some people who have respiratory failure become extremely sleepy or lose consciousness if their brain does not get enough oxygen or if carbon dioxide levels are very high.

Symptoms of respiratory failure in newborns include rapid breathing, grunting, widening of the nostrils with each breath, a bluish tone to the skin and lips, and a pulling inward of the muscles between the ribs while breathing. 

Respiratory failure may cause damage to the lungs and other organs including the brain and kidneys, so it is important to get treated quickly

Your doctor will ask you or your family members about your medical history and risk factors, especially any medical conditions that may affect your lungs and breathing. Your doctor will also ask if you have any symptoms of respiratory failure such as shortness of breath, rapid breathing, and confusion.

During a physical exam, your doctor may do the following:

• Check for a bluish color on your lips, fingers, or toes.
• Listen to your heart with a stethoscope to check for a fast or irregular heartbeat.
• Listen to your lungs with a stethoscope for rapid breathing or any unusual sounds when you breathe. He or she will also see if your chest moves unevenly while you breathe.
• Measure your blood oxygen level with a clip on a finger, called pulse oximetry.
• Measure your blood pressure to check if it is too high or low.
• Measure your temperature to check for a fever and ask if you have recently had a fever.

Diagnostic tests and procedures

To diagnose respiratory failure, your doctor may order some of the following tests and procedures.

• Arterial blood gas tests measure levels of oxygen, carbon dioxide, pH, and bicarbonate. A sample of your blood will be taken from your arteries. These tests help determine whether you have respiratory failure and what type it is.
• Blood tests can help find the cause of your respiratory failure. Blood tests can also help your doctor see how well your other organs are working.
• Bacterial cultures can show a bacterial infection in samples of your blood, urine, or phlegm (a slimy substance that you cough out).
• Bronchoscopy can show blockages, tumors, or other possible causes of respiratory failure.
• Lung imaging tests show detailed images of the lungs and can reveal any possible inflammation or damage.
• Heart tests such as electrocardiogram and echocardiography show how well your heart is working.
• A lung biopsies shows changes in the cells of your lung tissue or tiny germs or microbes causing infections.
• Lung function tests measure how well your lungs are working.

Acute respiratory failure can be life-threatening and may need a quick diagnosis and emergency medical treatment in a hospital. Emergency treatment can help quickly improve your breathing and provide oxygen to your body to help prevent organ damage. Your healthcare provider will then treat the cause of your respiratory failure. Treatments for respiratory failure may include oxygen therapy, medicines, and procedures to help your lungs rest and heal.

Chronic respiratory failure can often be treated at home. If you have serious chronic respiratory failure, you may need treatment in a long-term care center.

Oxygen therapy

If you have respiratory failure, you may receive oxygen therapy. There are different ways to get oxygen into your lungs.

• A noninvasive positive pressure ventilation (NPPV) uses mild air pressure to keep your airways open. You may wear plastic tubes on your nose, or a mask, or another device that fits over your nose or your nose and mouth. A tube connects the mask to a machine that blows air into the tube. Continuous positive airway pressure (CPAP) is one type of NPPV.
• Bag mask ventilation uses a bag, which is attached to a mask that you wear, to pump more air into your lungs. This is often done while you are waiting for a complex procedure to treat the cause of your respiratory failure.
• A mechanical ventilator is a machine that supports breathing. It blows air — or air with increased amounts of oxygen — into your airways and then your lungs. Your healthcare provider may treat you with a ventilator if the oxygen level in your blood doesn’t increase with NPPV, or if you're still having trouble breathing. Using a ventilator, especially for a long time, can damage your lungs and airways and cause infections such as pneumonia.
• A tracheostomy is a surgically made hole that goes through the front of your neck and into your windpipe. A breathing tube is placed in the hole to deliver oxygen when your airways are blocked.

• Extracorporeal membrane oxygenation (ECMO) pumps your blood through an artificial lung to add oxygen and remove carbon dioxide before returning the blood to your body. Healthcare providers use ECMO to treat people with severe breathing problems. It may be used for several days or weeks to give the lungs a chance to recover. Some complications of ECMO are blood clots, bleeding, and infections, all of which can be life-threatening.

Medicines

Your doctor may prescribe medicines to improve your symptoms or treat the cause of your respiratory failure.

• Antibiotics can treat bacterial lung infections such as pneumonia.
• Bronchodilators work by opening your airways.
• Corticosteroids control inflammation in the airways.

Treatments to manage other conditions or help you recover

If you have to stay in the hospital for a while, you may need treatments to avoid or manage other conditions or complications.

• Blood-thinning medicine: If you are very sick or got sick very quickly, this medicine can prevent blood clots from forming. If you cannot use a blood thinner for some reason, your doctor may order special stockings or devices to increase the pressure on your legs.
• Fluids: Fluids improve blood flow throughout your body and keep you hydrated. Fluids are usually given through an intravenous (IV) line inserted in one of your blood vessels.
• Nutritional support: You may need a feeding tube to make sure you get enough of the right nutrients while you are on a ventilator.
• Physical therapy: This can help maintain muscle strength and prevent sores from forming. Movement may also help shorten the time you are on a ventilator and improve recovery after you leave the hospital.
• Positioning your body: For severe respiratory failure, your doctor may recommend that you spend most of the time lying face down, which helps oxygen get to more of your lungs.
• Pulmonary rehabilitation: This program of education and exercise teaches you breathing techniques that can improve your oxygen levels.

If you have chronic respiratory failure, your symptoms may suddenly get worse. Call 9-1-1 for help if you suddenly have trouble breathing or talking.

Recovering from respiratory failure

As you recover from respiratory failure, it is important to follow your treatment plan, get regular follow-up care, and adopt healthy lifestyle changes.

• Talk to your doctor about when you can resume normal activities. Your oxygen and carbon dioxide levels may take a while to return to a healthy range. Because of this, you may continue to have shortness of breath or other symptoms for a few weeks or longer. You may need to do daily activities more slowly.
• Watch for warning signs of complications if you had to use a mechanical ventilator. Using a ventilator for a long time may hurt your lungs and windpipe. Learn more about the risks of being on a ventilator and what to watch for.  
• Talk to your doctor about pulmonary rehabilitation. This is an exercise training, education, and counseling program that can help your lungs work better.

Prevent complications if you have chronic respiratory failure

If you have chronic respiratory failure, you will likely need ongoing care to prevent damage to your lungs and other organs. You may also have to carry a portable oxygen tank and a tube that goes into your nose, called a cannula, with you.

Your doctor may talk to you about ways to prevent complications.

• Quit smoking. Talk to your healthcare provider about programs and products that can help you quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
• Avoid lung irritants, such as air pollution, chemical fumes, dusts, and secondhand smoke.
• Avoid or limit alcohol. Talk to your healthcare providers about how much alcohol you drink. They may recommend that you limit or stop drinking alcohol. You should also avoid recreational drugs. 
• Get recommended vaccines. Your healthcare provider may ask you and anyone who lives with you to get regular vaccines, a vaccine for pneumococcus, and a flu shot every year.

Know when to seek help

Keep phone numbers handy for your doctor, the hospital, and someone who can take you for medical care. You should also have directions to the doctor's office and hospital and a list of all the medicines you're taking on hand.

Take care of your mental health

Living with chronic respiratory failure may cause fear, anxiety, depression, and stress. Talk about how you feel with your healthcare provider or a professional counselor. They can help you find or learn ways to cope.

• Get treatment for depression. If you are depressed, your healthcare provider may recommend medicines or other treatments that can improve your quality of life.
• Join a patient support group. You can learn how other people who have similar symptoms have coped with them. Your provider may be able to help you find local support groups, or you can check with an area medical center.
• Seek support from family and friends. Letting your loved ones know how you feel and what they can do to help you can help lower stress and anxiety.

If you have a condition that puts you at risk of respiratory failure, talk to your healthcare provider. They can ask questions and do a physical exam to look for issues that may put you at risk of getting respiratory failure in the future. You can also talk with them about how to manage your condition to prevent respiratory failure. They can also screen you if you have a planned surgery.

There are things you can do to keep your lungs healthy, including not smoking, quitting or limiting alcohol, and not misusing opioids or taking recreational drugs.

Your doctor may also talk to you about other healthy lifestyle changes that can help lower your risk. This may include being physically active, choosing a diet such as the DASH eating plan, aiming for a healthy weight, managing stress, and getting good-quality sleep.

What is respiratory failure?

Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.

What causes respiratory failure?

Conditions that affect your breathing can cause respiratory failure. These conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These conditions include:

• Diseases that affect the lungs, such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, pulmonary embolism, and COVID-19
• Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
• Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
• Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
• Drug or alcohol overdose
• Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes

What are the symptoms of respiratory failure?

The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color. A high carbon dioxide level can cause rapid breathing and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

How is respiratory failure diagnosed?

Your health care provider will diagnose respiratory failure based on:

• Your medical history
• A physical exam, which often includes
  • Listening to your lungs to check for abnormal sounds
  • Listening to your heart to check for arrhythmia
  • Looking for a bluish color on your skin, lips, and fingernails
• Diagnostic tests, such as
  • Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
  • Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

Once you are diagnosed with respiratory failure, your provider will look for what is causing it. Tests for this often include a chest x-ray. If your provider thinks you may have arrhythmia because of the respiratory failure, you may have an EKG (electrocardiogram). This is simple, painless test that detects and records your heart's electrical activity.

What are the treatments for respiratory failure?

Treatment for respiratory failure depends on:

• Whether it is acute (short-term) or chronic (ongoing)
• How severe it is
• What is causing it

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include:

• Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
• Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe.
• Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs.
• Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. Another treatment is a special bed that rocks back and forth, to help you breathe in and out.
• Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition.
• Medicines for discomfort
• Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.