Acute respiratory failure - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute respiratory failure results from acute or chronic impairment of gas exchange between the lungs and the blood causing hypoxia with or without hypercapnia.
Patients may present with shortness of breath, anxiety, confusion, tachypnea, cardiac dysfunction, and cardiac arrest. Central nervous system depression can occur as a result of lack of oxygenation of the blood and vital organs or excessive accumulation of carbon dioxide.
Pulse oximetry, chest x-rays, blood gas analysis, and end-tidal carbon dioxide monitoring (capnometry) are key diagnostic tests.
Management involves first ensuring that the upper airway is patent and clear of obstructions. Supplemental oxygenation and ventilatory support are likely to be required, with immediate attention to the underlying cause or causes for respiratory failure.
Endotracheal intubation and mechanical ventilation are employed when other less invasive maneuvers have failed.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Spirometry results for normal, restrictive, and obstructive patterns

Citations

Key Articles

Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017 Aug 31;50(2):1602426.[Abstract][Full Text]
Davidson C, Banham S, Elliott, et al. British Thoracic Society/Intensive Care Society guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. BMJ Open Respir Res. 2016 Mar 14;3(1):e000133.[Abstract][Full Text]

Referenced Articles

1. Mirabile VS, Shebl E, Sankari A, et al. Respiratory failure in adults. Treasure Island (FL): StatPearls Publishing; 2023 [internet publication].[Full Text]
2. International Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) 2022. Acute respiratory failure. Diagnosis code CB41.0 [internet publication].[Full Text]
3. International Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) 2022. Chronic respiratory failure. Diagnosis code CB41.1 [internet publication].[Full Text]
4. International Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) 2022. Hypoxaemic respiratory failure. Diagnosis code CB41.1 [internet publication].[Full Text]
5. Sue DY, Lewis DA. Respiratory failure. In: Current critical care diagnosis and treatment. 3rd ed. Bongard FS, Sue DY, Vintch JRE, eds. New York, NY: Lange Medical Books/McGraw Hill: 2008;247-313.
6. International Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) 2022. Hypercapnic respiratory failure. Diagnosis code CB41.21 [internet publication].[Full Text]
7. Luhr OR, Antonsen K, Karlsson M, et al; the ARF Study Group. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. Am J Respir Crit Care Med. 1999 Jun;159(6):1849-61.[Abstract][Full Text]
8. Lewandowski K, Metz J, Deutschmann C, et al. Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany. Am J Respir Crit Care Med. 1995 Apr;151(4):1121-5.[Abstract]
9. Linko R, Okkonen M, Pettilä V, et al. Acute respiratory failure in intensive care units. FINNALI: a prospective cohort study. Intensive Care Med. 2009 Aug;35(8):1352-61.[Abstract]
10. Stefan MS, Shieh MS, Pekow PS, et al. Epidemiology and outcomes of acute respiratory failure in the United States, 2001 to 2009: a national survey. J Hosp Med. 2013 Feb;8(2):76-82.[Abstract]
11. World Health Organization. Pneumonia in Children. Nov 2022 [internet publication].[Full Text]
12. Murphy SL, Xu J, Kochanek KD, et al. Deaths: final data for 2019. Natl Vital Stat Rep. 2021 Jul;70(8):1-87.[Abstract][Full Text]
13. Hendrickson KW, Peltan ID, Brown SM. The epidemiology of acute respiratory distress syndrome before and after coronavirus disease 2019. Crit Care Clin. 2021 Oct;37(4):703-16.[Abstract][Full Text]
14. Oud L, Garza J. The contribution of COVID-19 to acute respiratory distress syndrome-related mortality in the United States. J Clin Med Res. 2023 May;15(5):279-81.[Abstract][Full Text]
15. Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med. 2020 May;8(5):433-34.[Abstract][Full Text]
16. Rostron BL, Chang CM, Pechacek TF. Estimation of cigarette smoking-attributable morbidity in the United States. JAMA Intern Med. 2014 Dec;174(12):1922-8.[Abstract][Full Text]
17. Tashkin DP. Marijuana and lung disease. Chest. 2018 Sep;154(3):653-63.[Abstract]
18. Kaur G, Pinkston R, Mclemore B, et al. Immunological and toxicological risk assessment of e-cigarettes. Eur Respir Rev. 2018 Feb 28;27(147):170119.[Abstract][Full Text]
19. Crossfield SSR, Chaddock NJM, Iles MM, et al. Interplay between demographic, clinical and polygenic risk factors for severe COVID-19. Int J Epidemiol. 2022 Oct 13;51(5):1384-95.[Abstract][Full Text]
20. Salabei JK, Asnake ZT, Ismail ZH, et al. COVID-19 and the cardiovascular system: an update. Am J Med Sci. 2022 Aug;364(2):139-47.[Abstract][Full Text]
21. Lu H, Zhao Y, Xu L, et al. Risk factors for acute respiratory failure in individuals with trauma: a meta-analysis. Asian J Surg. 2022 Mar;45(3):886-87.[Abstract][Full Text]
22. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017 Aug 31;50(2):1602426.[Abstract][Full Text]
23. Szász AZ, Székely-Vass ED, Lovász GT, et al. Acute respiratory failure, ischemic modifications on electrocardiogram: alternative etiology-A case of morgagni hernia. Medicina (Kaunas). 2022 Jan 28;58(2).[Abstract][Full Text]
24. Li K, Wu J, Wu F, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol. 2020 Jun;55(6):327-31.[Abstract][Full Text]
25. Yuan X, Liu L, Chang W, et al. Diagnosis accuracy of lung ultrasound for ARF in critically Ill patients: a systematic review and meta-analysis. Front Med (Lausanne). 2021;8:705960.[Abstract][Full Text]
26. Ierardi AM, Angileri SA, Arrichiello A, et al. Pulmonary embolism in COVID-19: ventilation and perfusion computed tomography. IDCases. 2020;21:e00805.[Abstract][Full Text]
27. Jubran A. Pulse oximetry. Crit Care. 1999;3(2):R11-R17.[Abstract][Full Text]
28. Ventriglia WJ. Arterial blood gases. Emerg Med Clin North Am. 1986 May;4(2):235-51.[Abstract]
29. Berend K, de Vries AP, Gans RO. Physiological approach to assessment of acid-base disturbances. N Engl J Med. 2014 Oct 9;371(15):1434-45.[Abstract]
30. Woller SC, Stevens SM, Adams DM, et al. Assessment of the safety and efficiency of using an age-adjusted D-dimer threshold to exclude suspected pulmonary embolism. Chest. 2014 Dec;146(6):1444-51.[Abstract]
31. Tresoldi S, Kim YH, Baker SP, et al. MDCT of 220 consecutive patients with suspected acute pulmonary embolism: incidence of pulmonary embolism and of other acute or non-acute thoracic findings. Radiol Med. 2008 Apr;113(3):373-84.[Abstract]
32. Perrier A, Roy PM, Sanchez O, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005 Apr 28;352(17):1760-8.[Abstract][Full Text]
33. Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007 Dec 19;298(23):2743-53.[Abstract][Full Text]
34. Scarsbrook AF, Gleeson FV. Investigating suspected pulmonary embolism in pregnancy. BMJ. 2007 Feb 24;334(7590):418-9.[Abstract][Full Text]
35. Phillips JJ, Straiton J, Staff RT. Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: a systematic review and meta-analysis of the literature, and cost and dose comparison. Eur J Radiol. 2015 Jul;84(7):1392-400.[Abstract]
36. Zieleskiewicz L, Arbelot C, Hammad E, et al. Lung ultrasound: clinical applications and perspectives in intensive care unit [in French]. Ann Fr Anesth Reanim. 2012 Oct;31(10):793-801.[Abstract]
37. Silva S, Biendel C, Ruiz J, et al. Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice. Chest. 2013 Sep;144(3):859-65.[Abstract]
38. Huttmann SE, Windisch W, Storre JH. Techniques for the measurement and monitoring of carbon dioxide in the blood. Ann Am Thorac Soc. 2014 May;11(4):645-52.[Abstract][Full Text]
39. Kelly AM, Klim S. Agreement between arterial and transcutaneous PCO2 in patients undergoing non-invasive ventilation. Respir Med. 2011 Feb;105(2):226-9.[Abstract]
40. Wahr JA, Tremper KK, Diab M. Pulse oximetry. Respir Care Clin N Am. 1995 Sep;1(1):77-105.[Abstract]
41. British Thoracic Society and Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. July 2019 [internet publication].[Full Text]
42. McFadden ER. Pulmonary function testing. In: Dale DC, ed. ACP medicine. New York, NY: WebMD Professional Publishing; 2007:2674-86.
43. Moss M, Ingram RH. Respiratory failure. In: Dale DC, ed. ACP medicine. New York, NY: WebMD Professional Publishing; 2007:2719-29.
44. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005 Jul;26(1):153-61.[Abstract][Full Text]
45. Leeies M, Flynn E, Turgeon AF, et al. High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. Syst Rev. 2017 Oct 16;6(1):202.[Abstract][Full Text]
46. Monro-Somerville T, Sim M, Ruddy J, et al. The effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure: a systematic review and meta-analysis. Crit Care Med. 2017 Apr;45(4):e449-56.[Abstract]
47. Ni YN, Luo J, Yu H, et al. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation?: A systematic review and meta-analysis. Chest. 2017 Apr;151(4):764-75.[Abstract]
48. Qaseem A, Etxeandia-Ikobaltzeta I, Fitterman N, et al. Appropriate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure: a clinical guideline from the American College of Physicians. Ann Intern Med. 2021 Jul;174(7):977-84.[Abstract][Full Text]
49. Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018 Apr 28;391(10131):1693-705.[Abstract]
50. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Jul 2019 [internet publication].[Full Text]
51. Davidson C, Banham S, Elliott, et al. British Thoracic Society/Intensive Care Society guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. BMJ Open Respir Res. 2016 Mar 14;3(1):e000133.[Abstract][Full Text]
52. Naughton MT, Rahman MA, Hara K, et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation. 1995 Mar 15;91(6):1725-31.[Abstract]
53. Cabrini L, Landoni G, Oriani A, et al. Noninvasive ventilation and survival in acute care settings: a comprehensive systematic review and metaanalysis of randomized controlled trials. Crit Care Med. 2015 Apr;43(4):880-8.[Abstract]
54. Schönhofer B, Kuhlen R, Neumann P, et al. Non-invasive mechanical ventilation in acute respiratory failure [in German]. Pneumologie. 2008 Aug;62(8):449-79.[Abstract]
55. Liao H, Pei W, Li H, et al. Efficacy of long-term noninvasive positive pressure ventilation in stable hypercapnic COPD patients with respiratory failure: a meta-analysis of randomized controlled trials. Int J Chron Obstruct Pulmon Dis. 2017 Oct 10;12:2977-85.[Abstract][Full Text]
56. Kaya A, Ciledag A, Cayli I, et al. Associated factors with non-invasive mechanical ventilation failure in acute hypercapnic respiratory failure. Tuberk Toraks. 2010;58(2):128-34.[Abstract]
57. Osadnik CR, Tee VS, Carson-Chahhoud KV, et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Jul 13;7:CD004104.[Abstract][Full Text]
58. Lazarus SC. Clinical practice: emergency treatment of asthma. N Engl J Med. 2010 Aug 19;363(8):755-64.[Abstract]
59. Green E, Jain P, Bernoth M. Noninvasive ventilation for acute exacerbations of asthma: a systematic review of the literature. Aust Crit Care. 2017 Nov;30(6):289-97.[Abstract]
60. American College of Emergency Physicians. Mechanical ventilation. Feb 2023 [internet publication].[Full Text]
61. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council guidelines 2021: adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract][Full Text]
62. Colquhoun MC, Handley AJ, Evans TR. ABC of resuscitation. 5th ed. London: BMJ Publishing Group; 2004.
63. Chrimes N, Higgs A, Hagberg CA, et al. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies. Anaesthesia. 2022 Dec;77(12):1395-415. [Abstract][Full Text]
64. Lamm WJ, Graham MM, Albert RK. Mechanism by which prone position improves oxygenation in acute lung injury. Am J Respir Crit Care Med. 1994 Jul;150(1):184-93.[Abstract]
65. Sud S, Friedrich JO, Taccone P, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med. 2010 Apr;36(4):585-99.[Abstract]
66. Tiruvoipati R, Bangash M, Manktelow B, et al. Efficacy of prone ventilation in adult patients with acute respiratory failure: a meta-analysis. J Crit Care. 2008 Mar;23(1):101-10.[Abstract]
67. Sud S, Sud M, Friedrich JO, et al. Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. CMAJ. 2008 Apr 22;178(9):1153-61.[Abstract][Full Text]
68. Kopterides P, Siempos II, Armaganidis A. Prone positioning in hypoxemic respiratory failure: meta-analysis of randomized controlled trials. J Crit Care. 2009 Mar;24(1):89-100.[Abstract]
69. Guttormson JL, Khan B, Brodsky MB, et al. Symptom assessment for mechanically ventilated patients: principles and priorities: an Official American Thoracic Society workshop report. Ann Am Thorac Soc. 2023 Apr;20(4):491-98.[Abstract][Full Text]
70. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416.[Abstract][Full Text]
71. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002 Apr 1;165(7):867-903.[Abstract][Full Text]
72. Girault C, Bubenheim M, Abroug F, et al. Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial. Am J Respir Crit Care Med. 2011 Sep 15;184(6):672-9.[Abstract]
73. British Thoracic Society. BTS Pleural disease guideline 2010. August 2010 [internet publication]. [This guideline has been archived by the British Thoracic Society. The BTS website states that guidelines that are more than 5 years old are marked as archived because their recommendations have not been checked to confirm continued validity at the date of archival. A BMJ Best Practice expert adviser has confirmed that these guidelines still reflect current practice in the UK.][Full Text]
74. National Patient Safety Agency. Rapid response report: risks of chest drain insertion. May 2008. http://www.nrls.npsa.nhs.uk/ (last accessed 26 October 2017). [Full Text]
75. Akram AR, Hartung TK. Intercostal chest drains: a wake-up call from the National Patient Safety Agency rapid response report. J R Coll Physicians Edinb. 2009;39:117-120. [Full Text]
76. American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) student course manual. 8th ed. Chicago, IL: American College of Surgeons; 2008.
77. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract][Full Text]
78. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract][Full Text]
79. Calder I, Pearce A, eds. Core topics in airway management. 2nd ed. Cambridge: Cambridge University Press; 2011.
80. Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021 Apr;161:115-51.[Abstract]
81. Noveanu M, Breidthardt T, Reichlin T, et al. Effect of oral beta-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study. Crit Care. 2010;14(6):R198.[Abstract][Full Text]
82. Combes A, Brodie D, Bartlett R, et al.; The International ECMO Network (ECMONet). Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014 Sep 1;190(5):488-96.[Abstract][Full Text]
83. Munshi L, Telesnicki T, Walkey A, et al. Extracorporeal life support for acute respiratory failure. A systematic review and metaanalysis. Ann Am Thorac Soc. 2014 Jun;11(5):802-10.[Abstract]
84. MacLaren G, Fisher D, Brodie D. Treating the most critically Ill patients with COVID-19: the evolving role of extracorporeal membrane oxygenation. JAMA. 2022 Jan 4;327(1):31-2.[Abstract][Full Text]
85. McDermott CJ, Bradburn MJ, Maguire C, et al; DiPALS Writing Committee; DiPALS Study Group Collaborators. Safety and efficacy of diaphragm pacing in patients with respiratory insufficiency due to amyotrophic lateral sclerosis (DiPALS): a multicentre, open-label, randomised controlled trial. Lancet Neurol. 2015 Sep;14(9):883-892.[Abstract][Full Text]
86. Oczkowski S, Ergan B, Bos L, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J. 2022 Apr;59(4):2101574.[Abstract][Full Text]
87. O'Driscoll BR, Howard LS, Earis J, et al; British Thoracic Society Emergency Oxygen Guideline Group; BTS Emergency Oxygen Guideline Development Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017 Jun;72(suppl 1):ii1-ii90.[Abstract][Full Text]
88. National Center for Health Statistics. Pneumonia. Jan 2017 [internet publication].[Full Text]
89. Muscedere J, Dodek P, Keenan S, et al. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. J Crit Care. 2008 Mar;23(1):126-37.[Abstract]
90. Mounier R, Lobo D, Voulgaropoulos J, et al. The multistep road to ventilator-associated lung abscess: a retrospective study of S.aureus ventilator-associated pneumonia. PLoS One. 2017 Dec 20;12(12):e0189249.[Abstract][Full Text]