What are the clinical findings of a client with acute respiratory failure?

Type I respiratory failure is when the lungs are not able to get enough oxygen into the blood. This causes the blood oxygen level to drop.

Type II respiratory failure is when carbon dioxide is not passing from the lungs out of the body. This causes carbon dioxide to build up in the blood.

A person may have one type of acute respiratory failure or have both types at the same time.

What are the causes?

Common causes of type I respiratory failure include:

• Trauma to the lung, chest, ribs, or tissues around the lung.

• Pneumonia.

• Lung diseases, such as pulmonary fibrosis or asthma.

• Smoke, chemical, or water inhalation.

• A blood clot in the lungs (pulmonary embolism).

• A blood infection (sepsis).

• Heart attack.

Common causes of type II respiratory failure include:

• Stroke.

• A spinal cord injury.

• A drug or alcohol overdose.

• A blood infection (sepsis).

• Cardiac arrest.

What increases the risk?

This condition is more likely to develop in people who have:

• Lung diseases such as asthma or chronic obstructive pulmonary disease (COPD).

• A condition that damages or weakens the muscles, nerves, bones, or tissues that are involved in breathing, such as myasthenia gravis or Guillain–Barré syndrome.

• A serious infection.

• A health problem that blocks the unconscious reflex that is involved in breathing, such as hypothyroidism or sleep apnea.

What are the signs or symptoms?

Trouble breathing is the main symptom of acute respiratory failure. Symptoms may also include:

• Fast breathing.

• Restlessness or anxiety.

• Breathing loudly (wheezing) and grunting.

• Fast or irregular heartbeats (palpitations).

• Confusion or changes in behavior.

• Feeling tired (fatigue), sleeping more than normal, or being hard to wake.

• Skin, lips, or fingernails that appear blue (cyanosis).

How is this diagnosed?

This condition may be diagnosed based on:

• Your medical history and a physical exam. Your health care provider will listen to your heart and lungs to check for abnormal sounds.

• Tests to confirm the diagnosis and determine the cause of respiratory failure. These tests may include:

  • Measuring the amount of oxygen in your blood (pulse oximetry). The measurement comes from a small device that is placed on your finger, earlobe, or toe.

  • Blood tests to measure blood oxygen and carbon dioxide and to look for signs of infection.

  • Tests on a sample of the fluid that surrounds the spinal cord (cerebrospinal fluid) or a sample of fluid that is drawn from the windpipe (trachea) to check for infections.

  • Chest X-ray.

  • Electrocardiogram (ECG) to look at the heart's electrical activity.

How is this treated?

Treatment for this condition usually takes place in a hospital intensive care unit (ICU). Treatment depends on what is causing the condition. It may include one or more of these treatments:

• Oxygen may be given through your nose or a face mask.

• A device such as a continuous positive airway pressure (CPAP) machine or bi-level positive airway pressure (BIPAP) machine may be used to help you breathe. The device gives you oxygen and pressure.

• Breathing treatments, fluids, and other medicines may be given.

• A ventilator may be used to help you breathe. The machine gives you oxygen and pressure. A tube is put into your mouth and trachea to connect the ventilator.

  • If this treatment is needed longer term, a tracheostomy may be placed. A tracheostomy is a breathing tube put through your neck into your trachea.

• In extreme cases, extracorporeal life support (ECLS) may be used. This treatment temporarily takes over the function of the heart and lungs, supplying oxygen and removing carbon dioxide. ECLS gives the lungs a chance to recover.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.

• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.

• If you are taking blood thinners:

  • Talk with your health care provider before you take any medicines that contain aspirin or NSAIDs, such as ibuprofen. These medicines increase your risk for dangerous bleeding.

  • Take your medicine exactly as told, at the same time every day.

  • Avoid activities that could cause injury or bruising, and follow instructions about how to prevent falls.

  • Wear a medical alert bracelet or carry a card that lists what medicines you take.

General instructions

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

• Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.

• Do not drink alcohol if:

  • Your health care provider tells you not to drink.

  • You are pregnant, may be pregnant, or are planning to become pregnant.

• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.

• Attend any physical therapy and pulmonary rehabilitation as told by your health care provider.

• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• If you have an infection or a medical condition that may lead to acute respiratory failure, make sure you get proper treatment.

Contact a health care provider if:

• You have a fever.

• Your symptoms do not improve or they get worse.

Get help right away if:

• You are having trouble breathing.

• You lose consciousness.

• You develop a fast heart rate.

• Your fingers, lips, or other areas turn blue.

• You are confused.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Acute respiratory failure is a medical emergency. It can develop quickly, and it should be treated right away.

• Treatment for this condition usually takes place in a hospital intensive care unit (ICU). Treatment may include oxygen, fluids, and medicines. A device may be used to help you breathe, such as a ventilator.

• Take over-the-counter and prescription medicines only as told by your health care provider.

• Contact a health care provider if your symptoms do not improve or if they get worse.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

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