Acute Respiratory Failures

Acute respiratory failure is a severe condition in which the respiratory system fails to provide adequate oxygen to the body, preventing it from functioning normally, or fails to remove carbon dioxide properly, causing it to accumulate in the blood and damage both tissues and organs. Its cause is usually a chronic lung disease that worsens suddenly or a severe lung condition that develops abruptly in people without prior lung problems.

Depending on the impaired lung function, two types of acute respiratory failure can be distinguished, which can occur simultaneously:

• Hypoxemic respiratory failure: There is a deficiency in oxygenation.
• Hypercapnic respiratory failure: There is a deficiency in ventilation, and carbon dioxide is not properly eliminated.

Acute respiratory failures represent a dangerous and potentially life-threatening medical emergency.

Symptoms

The symptoms of acute respiratory failure primarily depend on its cause and the levels of oxygen and carbon dioxide in the blood.

Symptoms of hypoxemia:

• Extreme fatigue
• Dyspnea: difficulty breathing, shortness of breath
• Drowsiness
• Loss of consciousness
• Cyanosis: bluish discoloration of the fingers and lips in light-skinned individuals and grayish or whitish coloration in dark-skinned individuals.

Symptoms of hypercapnia:

• Deep and rapid breathing
• Cardiac arrhythmia
• Drowsiness
• Confusion
• Blurred vision
• Headache
• Loss of consciousness

Causes

The causes of acute respiratory failure can be divided into two groups, based on the impaired function:

Hypoxemic respiratory failure:

• Conditions that cause abnormalities in lung tissue, such as acute respiratory distress syndrome, pneumonia, excess fluid in the lungs, or pulmonary fibrosis.
• A blood clot that reduces blood flow to the lungs.

Hypercapnic respiratory failure:

• Pulmonary injuries
• Damage to the bones and tissues surrounding the lungs
• Weakness in the muscles responsible for inflating the lungs
• Obstruction or narrowing of the airways
• Hypothyroidism
• Sleep apnea
• Sedation induced by opioids or alcohol, as these conditions reduce the unconscious respiratory reflex.

Risk Factors

Factors that increase the likelihood of developing respiratory failure include:

• Age: Aging deteriorates respiratory capacity, thoracic elasticity, and muscle mass. Premature infants may have underdeveloped lungs.
• Drug or alcohol abuse.
• Smoking.
• Pulmonary irritants in the environment, such as air pollution, chemical fumes, dyes, paints, or tobacco smoke.
• Chest trauma.
• Neurodegenerative disorders.
• Pulmonary and cardiac diseases.
• Obesity: Excess fat makes it harder for the diaphragm to work, breathing becomes shallow, and insufficient oxygen reaches the lungs.

Complications

If acute respiratory failure is not treated, both the lack of oxygen and the excess of carbon dioxide in the blood can lead to severe damage to the body, such as kidney and heart failure, thromboembolisms, or neurological alterations, eventually leading to multi-organ failure with a fatal prognosis.

Prevention

To reduce the risk of respiratory failure, several measures can be taken to keep the lungs healthy:

• Avoid smoking and drugs.
• Limit alcohol and opioid consumption.
• Exercise regularly.
• Maintain a healthy weight.

Which doctor treats acute respiratory failures?

Acute respiratory failure is treated by specialists in pulmonology, emergency medicine, and intensive care.