Respiratory Failure

Respiratory failure occurs when your lungs are unable to pass enough oxygen through to your blood, or when they fail to remove carbon dioxide from the blood, impairing the functionality of your body’s organs. Treatment depends on whether the condition is short-term (acute) or ongoing (chronic) and its severity.

Pulmonologists and thoracic surgeons who specialize in respiratory failure at the Brigham and Women’s Hospital (BWH) Lung Center provide comprehensive, specialized care for patients experiencing respiratory failure. Their expertise and collaboration with other specialists throughout BWH provides patients with a highly-informed diagnosis and a cohesive treatment plan.

What are the types of respiratory failure?

The majority of cases of respiratory failure fall under one of the following two categories:

• Type I (hypoxemic) respiratory failure, also known as “oxygen failure”, is categorized by a low level of oxygen in the blood without an increased level of carbon dioxide in the blood. Type I respiratory failure is typically caused when the volume of air flowing in and out of the lungs is uneven with the flow of blood to the lungs.
• Type II (hypercapnic) respiratory failure, also known as “ventilatory failure,” takes place when alveolar ventilation is unable to efficiently remove carbon dioxide from the blood, causing it to build-up in the body.

Acute respiratory failure is a short-term condition that is treated as a medical emergency, while chronic respiratory failure develops over time and requires long-term treatment.

What are the risk factors for respiratory failure?

People who have conditions that affect the muscles, bones, nerves or tissues involved in breathing, or have lung diseases, are at risk for respiratory failure. Mortality rates increase with age and in the presence of additional diseases or disorders.

You may be at risk for respiratory failure if you:

• Smoke cigarettes or other tobacco products
• Drink alcohol excessively
• Have a family history of respiratory conditions
• Have sustained an injury to the chest, brain or spine
• Have chronic respiratory problems, such as lung cancer, chronic obstructive pulmonary disease (COPD) or asthma

What are the causes of respiratory failure?

Conditions and diseases that affect your breathing can cause respiratory failure. Some include:

• Lung diseases such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, pulmonary embolism and acute respiratory distress syndrome (ARDS)
• Conditions that affect the muscles and nerves that control breathing, such as spinal cord injuries, stroke, amyotrophic lateral sclerosis (ALS) and muscular dystrophy
• Damage to the ribs and lung tissues due to a chest injury
• Alcohol or drug overdose
• Acute lung injuries, such as those from inhaling harmful fumes or smoke

What are the symptoms of respiratory failure?

The symptoms of respiratory failure depend on its underlying cause and the levels of carbon dioxide and oxygen in the blood. Some symptoms include:

• Shortness of breath and feeling as if you cannot breathe enough air
• Bluish-colored skin, lips and fingernails
• Rapid breathing
• Exhaustion and/or confusion
• Loss of consciousness
• Arrhythmias (irregular heartbeats)

How is respiratory failure diagnosed?

Your physician will diagnose respiratory failure based on a careful review your medical history, a full physical examination and additional test results, including:

• Arterial blood gas test (ABG)
• Chest X-ray
• Electrocardiogram (EKG)
• Pulse oximetry

Once respiratory failure is diagnosed, your physician will look to determine its underlying cause to develop a treatment plan.

What is the treatment for respiratory failure?

Treatment for respiratory failure involves addressing any underlying conditions you may have, and depends upon whether your respiratory failure is acute (short-term) or chronic (ongoing). Acute respiratory failure typically requires immediate hospitalization in an intensive care unit. Chronic respiratory failure can often be treated at home, depending on its severity and underlying cause.

Treatment plans may include medication to alleviate discomfort, oxygen therapy, ventilator support or surgery.

Oxygen Therapy

You may receive oxygen therapy through a nasal cannula or a mask that covers your nose and mouth.

Ventilator Support

If the oxygen levels in your blood do not improve, your physician may recommend a ventilator. This machine supports breathing to help your body get an ample amount of oxygen until you are able to breathe on your own. Types of ventilator support include:

• Conventional mechanical ventilation (CVM), a form of life support in which a machine delivers air and oxygen through a tracheostomy or endotracheal tube.
• Extracorporeal membrane oxygenation (ECMO), a technique for providing respiratory support to patients whose heart and lungs cannot provide sufficient gas exchange to keep them alive.
• Non-invasive positive pressure ventilation (NVVP), mechanical support in which air and oxygen is administered through a noninvasive interface. NPPV can be delivered via a standard ICU ventilator or through a portable device, using:
• Continuous positive airway pressure (CPAP), applies mild air pressure consistently throughout a patient’s respiratory cycle.
• Bilevel positive airway pressure (BiPAP), the delivery of two pressure levels to complement the patient’s respiratory cycle to improve lung efficiency and make breathing easier.

Surgery

Surgery may be necessary depending on the severity of your respiratory failure and its underlying cause. Possible surgical interventions include:

• Lung transplantation
• Tracheostomy, an operation that creates a hole in the front of your neck and into your windpipe. A tube is usually inserted into the opening to form an artificial airway to improve breathing and remove lung secretions.

What can I expect?

A multidisciplinary team will work with you every step of the way, from diagnostics through evaluation, to create a cohesive and comprehensive treatment plan. Our unique approach features same day consultations with multiple specialists and fosters seamless, expert care. Your medical condition will be closely monitored and managed to promote optimal lung functioning and an improved quality of life.

If you require surgery, you will meet with your health care team first for pre-operative information and tests. On the day of your surgery, you will receive care from surgeons, anesthesiologists and nurses who specialize in thoracic surgery and interventional pulmonary procedures. After surgery, you will recover in our designated thoracic post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Team-based care

Respiratory failure patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, pulmonologists and imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any recommended surgery or procedure will be performed by an experienced, board-certified surgeon, in collaboration with the treatment team including nurses and physician assistants, all of whom specialize in caring for patients with respiratory failure.

Where are you located, and how do I book an appointment?

• Our Lung Center Team
• Request Lung Center Appointment
• Lung Center Locations

Do you have additional resources on respiratory failure?

Learn more about topics related to respiratory failure in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

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