What Is Respiratory Failure?
Respiratory failure is a pathological condition in which a person's blood does not have an adequate amount of oxygen or, on the other hand, has increased levels of carbon dioxide. Sometimes, a person can have both problems. Blood is responsible for carrying oxygen into a person's organs. When people breathe, their lungs take oxygen through the air passages, namely the trachea and the bronchus. The oxygen diffuses into the person's blood.
Organs, especially vital organs like the heart and brain, need oxygen-rich blood to work properly without causing major life-threatening problems. Another function of breathing is removing carbon dioxide from the blood carried away from the organs and breathing it out. An excess amount of carbon dioxide in the blood can harm a person's organs and lead to suffocation.
What Types of Respiratory Failure Exist?
Respiratory failure may manifest suddenly as acute or gradually over time as chronic. Two prevalent classifications are hypoxemic respiratory failure (type 1) and hypercapnic respiratory failure (type 2). Additional categories encompass perioperative respiratory failure (type 3), linked to surgery, and respiratory failure attributed to shock (type 4).
Hypoxemic Respiratory Failure
Hypoxemic respiratory failure occurs due to inadequate oxygen levels in the bloodstream (hypoxemia), often stemming from heart or lung conditions. It is alternatively referred to as hypoxic respiratory failure.
Hypercapnic Respiratory Failure
Hypercapnic respiratory failure occurs when there is an excess of carbon dioxide (CO2) in the bloodstream. If the body fails to eliminate this waste product, it impairs the capacity of blood cells to transport oxygen effectively. Common triggers include heart, lung, muscle, neurological conditions, and certain medications. It is also known as hypercarbia respiratory failure.
Perioperative Respiratory Failure
Perioperative respiratory failure may occur during surgery, often due to anesthesia hindering proper breathing. In some cases, lung air sacs can collapse (atelectasis), impeding the entry of oxygen into the bloodstream.
Respiratory Failure Stemming From Shock
Shock, characterized by low blood pressure, pulmonary edema (fluid in the lungs), and related complications, can precipitate respiratory failure. Shock can arise from conditions such as sepsis, cardiac events (e.g., heart attacks), and blood loss.
What Are the Causes of Respiratory Failure?
Any pathological condition that affects the breathing of an individual can lead to respiratory failure. These conditions might indirectly affect the muscles, nerves, bones, or tissues that aid breathing. It might also directly affect the lungs through any disease process or pathology. These conditions include the following:
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Lung disorders such as cystic fibrosis, obstructive pulmonary disease, pneumonia of varied etiology, and pulmonary embolism.
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Conditions that cause damage to the nerves and muscles that control breathing and support breathing, like amyotrophic lateral sclerosis, muscular dystrophies, spinal cord injuries naturally or by trauma, and stroke.
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Problems in the spine's structure, such as scoliosis, where the vertebral column is curved in a shape that resembles the alphabet S," can affect the normal supportive function of the bones and muscles used for breathing.
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Damage to the muscles and ribs around the lungs. An injury in the chest region might cause this damage.
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Drug or alcohol abuse.
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Inhalation injuries can be caused by inhaling the smoke from a fire incident or harmful fumes.
What Are the Symptoms of Respiratory Failure?
The symptoms of respiratory failure occur based on the etiology and the oxygen and carbon dioxide levels in the affected person's blood. A decrease in oxygen levels in the blood can lead to shortness of breath and air hunger, affecting individuals who cannot inhale enough air. Increased carbon dioxide levels can lead to rapid and forceful breathing and confusion. The person's skin, oral cavity, tongue, lips, and fingernails might present with a bluish color change called cyanosis. Some people affected by respiratory failure might experience extreme sleepiness or lose consciousness. They may also experience arrhythmia, which is an irregular heartbeat pattern. The affected person might have the above symptoms if their brains and hearts are not adequately getting enough oxygen.
What Are the Risk Factors for Respiratory Failure?
Risk factors contributing to respiratory failure encompass:
- Lung-related ailments include acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), pneumonia, asthma, cystic fibrosis, pulmonary edema, pulmonary embolism, and pulmonary fibrosis.
- Heart or circulatory disorders, including heart attacks, congenital heart diseases, heart failure, and shock.
- Afflictions affecting the nerves and muscles crucial for breathing, like muscular dystrophy, amyotrophic lateral sclerosis (ALS), severe scoliosis, and Guillain-Barré syndrome.
- Injuries to the chest, spinal cord, or brain, including strokes.
- Smoking or exposure to lung irritants like chemical fumes, dust, air pollution, and asbestos.
- Surgical procedures necessitate sedation or anesthesia.
- Substance abuse or excessive alcohol consumption.
- Age, with newborns (especially premature infants) and individuals over 65 being at heightened risk of respiratory failure.
How Is Respiratory Failure Diagnosed?
Doctors will diagnose respiratory failure using the following tools in a hospital setting.
- Focused and thorough medical history of the patient.
A physical examination often includes the following-
- Listening to a person's lungs to look for abnormal sounds.
- Listening to the person's heart to look out for abnormal rhythms in the person's heartbeat.
- Look for discoloration on the person's skin, lips, tongue, buccal mucosa, and fingernails.
Diagnostic tests include the following:
- Pulse oximetry is a small sensor machine that uses light to measure the oxygen saturation levels in a person's blood. The sensor is frequently fitted on the end of the person's index finger or, rarely, on the ear.
- Arterial blood gas measurement is a test that helps measure the oxygen and carbon dioxide levels in a person's blood. In this process, a blood sample is collected from an artery, most commonly from the wrist.
- Once a person is diagnosed with respiratory failure, the healthcare provider will check for the disease's etiology in a very focused manner. Tests at this stage often include a chest x-ray in the anterior-posterior direction. If the healthcare provider doubts that the person might have arrhythmia due to respiratory failure, they might check the heart rhythm pattern through an EKG. This simple, painless diagnostic tool helps detect and record the affected person's heart's electrical activity.
What Are the Treatment Options?
Treatment of respiratory failure primarily focuses on:
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Whether the respiratory failure is acute or chronic at the onset.
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The severity of the respiratory failure.
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The underlying etiology of respiratory failure.
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Severe cases of respiratory failure are a medical emergency. The affected person will need treatment in the hospital intensive care unit for days to months. Chronic respiratory failure can mostly be treated at home. But if there is a sudden and severe flare-up in a person's chronic respiratory failure, they might need immediate treatment in long-term care.
Conclusion
Respiratory failure, stemming from various lung, heart, neurological, and traumatic conditions, presents a critical medical challenge. Factors such as smoking, substance abuse, and age further compound the risk. Awareness of these factors is paramount to preventing and managing respiratory failure, highlighting the importance of tailored interventions and vigilant monitoring in high-risk populations.
