Respiratory Failure

Medically Reviewed by Melinda Ratini, MS, DO on April 21, 2023
5 min read

Respiratory failure is a condition in which your lungs have a hard time loading your blood with oxygen or removing carbon dioxide. It can leave you with low oxygen, high carbon dioxide, or both.

If you aren’t getting enough oxygen into your blood, your doctor will call this hypoxemic or type 1 respiratory failure. If you have too much carbon dioxide, it’s called hypercapnic, hypercarbic, or type 2 respiratory failure.

Acute respiratory failure comes on quickly, and it's an emergency. But respiratory failure can also be chronic, a long-term problem that you'll need regular care to manage.

Breathing may seem like a simple act, but there are a lot of moving parts. A problem with any one of them can lead to respiratory failure, including:

Acute respiratory failure is more common with an injury to your brain, chest, or lungs. Things like choking, drowning, or getting hit in the chest could all do it. A sudden, serious illness that affects breathing, like acute respiratory distress syndrome (ARDS), can also bring it on.

You might have a higher risk of respiratory failure if you:


Your symptoms will depend on the cause and whether you have low oxygen, high carbon dioxide, or both. Some things you may notice are:

  • Bluish color to your fingernails, lips, and skin
  • Feeling that you just can't take in enough air
  • Confusion
  • Heartbeat that's off
  • Rapid breathing or extremely slow breathing
  • Shortness of breath
  • Sleepiness or passing out


You'll start with a physical exam and questions about your health. You'll then get one or both of these tests:

Pulse oximetry. Your doctor puts a small device on your finger or ear to measure your oxygen level.

Arterial blood gas test. This basic blood test measures your levels of oxygen and carbon dioxide.

You may need more tests to look for the cause. That might include things like a chest X-ray or an EKG, which measures electrical signals in your heart.

Your treatment might include:

Oxygen therapy. You breathe in oxygen, through either a mask or a thin tube with two prongs that sit just inside your nose. You can get a portable oxygen tank so you can still go out and about with it.

Ventilator. You might need one of these breathing machines if oxygen therapy isn't enough or if you can't breathe on your own. They blow air into your lungs so you get the oxygen you need without having to work so hard for it. They also help lower carbon dioxide levels.

There are a few types. With smaller, simpler ones, you wear a mask over your nose or mouth. A CPAP machine, used for sleep apnea, is one example.

For a more severe problem, you might need a breathing tube that goes down your throat.

Tracheostomy. This is surgery in which your doctor makes an opening in your neck and windpipe to put in a small tube. It's called a trach tube and can make breathing easier. You may also get this if you'll need a ventilator for more than a week or two. The ventilator connects directly to the trach tube.

Treating the cause. You might need care for the condition that caused your respiratory failure, too. That could mean things like:

  • Antibiotics for pneumonia
  • Drugs to break up blood clots
  • Inhaled medicines to open airways
  • Chest tube to drain blood or extra air in cases of injury

Your treatment will depend on the cause and whether your respiratory failure is chronic or acute. Acute and chronic cases aren’t treated the same way, but the ideas are similar:

Acute. You'll go to an ER, but if your treatment there doesn't solve the problem, you may need to stay overnight in the hospital. For severe symptoms, you may need to go to the intensive care unit (ICU). You may get oxygen therapy. And you may need a ventilator until you can breathe on your own. You'll also get medicine and fluids to ease your symptoms and treat the cause of your respiratory failure.

Chronic. You’ll get ongoing care in your home, which typically includes medication you take every day -- either inhaled medicine or drugs you take by mouth. In severe cases, you might need oxygen therapy.

Because respiratory failure can make it harder for you to sleep, you may also need extra help at night. That could mean one of the smaller ventilators, like a CPAP machine, to get more air into your lungs. Or you may need a special bed that rocks back and forth to help you breathe better. For more serious cases, you'll need a ventilator.

If you have acute respiratory failure, treatment right away can help get you back to your normal activities. With chronic respiratory failure, it’s important to follow your doctor’s advice about ongoing care. Know what your symptoms mean and when you might need to call your doctor.

Respiratory failure is serious, but many things can affect how you do, including what’s causing your condition.