What Are Acute and Chronic Respiratory Failure?

As you breathe in and out, your lungs need to do two things really well. They have to load up your blood with oxygen and yank out the carbon dioxide.

You have respiratory failure when there's a problem with either of those steps. So it can leave you with low oxygen, high carbon dioxide, or both. Any of those spells trouble, but your doctor can suggest ways to treat it.

When it's acute, it means it comes on quickly, and it's an emergency. If it's chronic, it's a long-term problem and you'll need regular care to manage the symptoms.

What Causes It?

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

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

Chronic respiratory failure usually comes along with long-term issues that affect your lungs and breathing, like COPD or severe asthma.

What Are the Symptoms?

It depends 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
  • Feeling confused
  • Heartbeat that's off
  • Rapid breathing or extremely slow breathing
  • Shortness of breath
  • Sleepiness or passing out

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How Will My Doctor Test for It?

You'll start with a physical exam and questions about your health history to try and pin down what's going on.

You'll then get one or both of these:

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

Arterial blood gas test. It's a basic blood test that measures your levels of oxygen and carbon dioxide.

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

How Is It Treated?

It depends on the cause and whether it's chronic or acute. You may need:

Oxygen therapy. You breathe in oxygen either through 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 different 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 where the 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 right to the trach tube.

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

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

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Do You Treat Acute and Chronic Cases the Same Way?

Not exactly, though the ideas are similar:

Acute. You'll head 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 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 support at night. That could mean one of the smaller ventilators, like a CPAP machine, to get more air in 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.

WebMD Medical Reference Reviewed by Carol DerSarkissian on June 19, 2018

Sources

SOURCES:

National Heart, Lung and Blood Institute: "Respiratory Failure," "Tracheostomy."

Merck Manual Consumer Version: "Respiratory Failure."

Brigham and Women's Hospital: "Respiratory Failure."

Denver Health: "Acute and Chronic Respiratory Failure."

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