Respiratory Failure in Adults

What is Respiratory Failure in Adults?

The respiratory system plays a crucial role in our body by helping to exchange gases with our surroundings – it supplies our body with oxygen and gets rid of carbon dioxide. Any failure in doing so leads to a condition termed “respiratory failure”. There are two types of respiratory failure. Type 1 happens when the respiratory system can’t provide enough oxygen for the body, leading to low oxygen levels, which is known as hypoxemia. Type 2 occurs when the respiratory system can’t remove enough carbon dioxide from the body, resulting in high carbon dioxide levels, or what is medically known as hypercapnia.

Respiratory failure can be acute (sudden), chronic (long-term), or acute on chronic (an acute event happening in a person with chronic respiratory failure). It’s extremely important to understand this condition, as neglecting either type of respiratory failure can rapidly become life-threatening, leading to severe outcomes such as difficulty to breathe, coma, and even death.

In this context, spotting possible signs of both types of respiratory failure in adults, as well as diagnosing and treating these conditions, whether acute or chronic, is discussed. Providing this information is intended to raise awareness about the symptoms and the steps one should take for timely medical intervention.

What Causes Respiratory Failure in Adults?

Respiratory failure is a serious condition that can happen if there is a problem with any part of the lungs or breathing system. This includes the upper and lower parts of the lungs, the central and peripheral nervous system (which controls our movements and sensory information), the chest wall, and the muscles that help us breathe.

This piece will cover the different causes of respiratory failure. Understanding these specific causes can help you understand why and how this condition occurs.

Risk Factors and Frequency for Respiratory Failure in Adults

Respiratory failure, a syndrome resulting from numerous health conditions, is somewhat tricky to track and understand. In 2017, the United States recorded an occurrence rate of 1,275 cases per 100,000 adults. Note that this study included any diagnosis that involved respiratory failure. The cause behind the respiratory failure often determines how common it is. Here are a few frequent causes and relevant information:

Acute Myocardial Infarction-related: Between 2000 and 2014, there were 439,436 hospital admissions related to this condition. Roughly 57% of these cases required mechanical ventilation.
Acute Respiratory Distress Syndrome: This condition’s occurrence varies between 10 to 80 per 100,000 people each year, depending on the location. This variation can be attributed to different standards for treating the condition across the world. In one study, it was estimated that 10% of all intensive care unit patients and 23% of mechanically ventilated patients met the criteria for this syndrome.
COVID-19 related: Early in the COVID-19 pandemic, it was estimated that up to 79% of hospitalized patients developed respiratory failure requiring intimate mechanical ventilation.
Acute exacerbation of Chronic Obstructive Pulmonary Disease: This is the third most common reason for hospital admission due to acute respiratory failure.

Signs and Symptoms of Respiratory Failure in Adults

Respiratory failure can be caused by a variety of things, so it’s important for doctors to conduct a thorough assessment to figure out the cause.

A person suffering from respiratory failure might show symptoms like difficulty breathing, coughing, coughing up blood, producing a lot of mucus, or wheezing. Other issues like chest pain, decreased appetite, heartburn, fever, and significant weight loss are also important. Being in contact with a COVID-19 patient or losing the sense of smell can be indicators of this disease, particularly in high-risk groups such as older patients, men, or extremely overweight individuals. People with compromised immune systems or taking immunosuppressants are also at higher risk.

For people already diagnosed with a respiratory disease, it’s important to check if they have been correctly using their inhalers, recently taken steroids, or been exposed to environmental triggers. Issues like high blood pressure and chronic cough could indicate usage of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers that should be investigated.

Social history plays a key role too. Drinking alcohol and having sexually transmitted diseases could weaken the immune system, increasing susceptibility to certain infections. Living a sedentary lifestyle could increase the risk of blood clots in the lungs. Certain habits and hobbies – like keeping birds, diving or flying – could suggest potential causes of respiratory failure. It is crucial to investigate if the person smokes cigarettes, marijuana, e-cigarettes, vapes, or is exposed to second-hand smoke.

An occupational history could reveal if the patient has been exposed to workplace-related lung diseases like hypersensitivity pneumonitis and pneumoconiosis. Family history could help to identify atopic, genetic conditions like alpha-1-antitrypsin deficiency and cystic fibrosis, and infectious diseases like tuberculosis.

Physical examination can reveal signs of respiratory failure throughout the body.

General inspection: Overuse of auxiliary muscles, altered mental status, thinness, dyspnea during conversation, sweating, fever, respiratory distress, obesity, and purse-lipped breathing
Head: Signs of high cortisol levels, bluish discoloration at the center of the face, Horner’s syndrome, and pale conjunctiva
Neck: Distended neck veins, swelling of the lymph nodes, and deviation of the trachea
Chest/thorax: Unsymmetrical chest expansion, slow breathing, odd breath sounds, shallow or rapid underwater-like sounds, decreased breath sounds, dullness to percussion, hollow sounds on percussion, labored breathing, kyphoscoliosis, loud P2 (second heart sound), abnormal or opposite breathing movements, pectus carinatum, pectus excavatum, pleural rub, reduced chest expansion, stridor, quick breathing, physical vibration while speaking, normal breath sound, vocal resonance, wheezing, and whispering pectoriloquy (whispered sounds that are clear and loud)
Abdomen: An enlarged liver
Upper extremities: Rapid, rhythmic, jerking movements, bulging fingertips, peripheral cyanosis, tobacco staining, and tremor
Lower extremities: Swelling, blue coloration, and unilateral swelling.

Testing for Respiratory Failure in Adults

Respiratory failure is a complex condition that can be caused by many different medical issues. Therefore, there isn’t a single ‘one-size-fits-all’ method to diagnose it. To identify what’s causing respiratory failure, doctors may use a range of tests. These can include blood tests (like complete blood count, metabolic panel, tests to check infections, and a hormone evaluation), a detailed heart check (with a 12-lead electrocardiography), and several other specific tests. Here are some of those tests explained in simpler terms:

Arterial Blood Gas (ABG)

The ABG test is a key method to diagnose respiratory failure. It measures the acid-base (pH) levels and the levels of oxygen (PaO2) and carbon dioxide (PaCO2) in your blood. It specifically taken from your arteries, which directly reflect the oxygen and carbon dioxide in all our body’s cells.

Oxygen levels less than 60 mmHg or carbon dioxide levels more than 45 mmHg indicate a breathing problem. This test also helps doctors tell the difference between short-term (acute) and long-term (chronic) respiratory failure.

Capnometry

Capnometry is a test that measures the amount of carbon dioxide you breathe out. If the results of this test differ significantly from the CO2 levels in arterial blood, it can indicate a problem with gas exchange in your lungs.

Radiography

Different imaging techniques can visualize the state of your lungs. Options include simple X-rays, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, angiography, and ultrasonography.

Pulse Oximetry

Pulse oximetry is a non-invasive test that estimates the level of oxygen in your blood. It does so by shining light through your skin and measuring how much light is absorbed. The amount of absorbed light varies with the levels of oxygen in your blood. It provides an indication of how well the lungs are oxygenating the body.

Ultrasonography

The BLUE-protocol (bedside lung ultrasound in emergency) is an ultrasound method used to diagnose acute respiratory failure at bedside in acute scenarios. It includes checking specific standard locations (BLUE points) of the chest and identifying specific ultrasound patterns that correlate with different underlying conditions.

Other techniques like bronchoscopy, echocardiography, sleep studies, and lung function tests can sometimes also be useful in diagnosing respiratory failure. If these tests are needed, a specialist in lung conditions (pulmonologist) can be consulted.

Treatment Options for Respiratory Failure in Adults

If you’re having trouble breathing, doctors will aim to treat the cause while providing support to help you breathe better, if necessary. This includes supporting your body as it gets the oxygen it needs and making sure gases in your blood are balanced properly.

When a patient comes in with severe breathing issues, the first steps doctors take include checking your airway, breathing, and circulation. These supportive measures will depend on having clear airways, maintaining a good oxygen supply, ventilating properly (getting rid of waste gases from the body), and correcting any issues related to the gases in your blood.

To correct low oxygen levels in your blood (hypoxemia), the goal is to maintain enough oxygen in your tissues, which can be measured by tests like blood gas analysis. Too much oxygen can cause harm, such as oxygen toxicity and carbon dioxide buildup in the body, so doctors will aim to adjust the oxygen concentrations to sufficient but safe levels of 90-94%.

Oxygen can be delivered in several ways depending on the situation. These might include a nasal cannula (a small tube that fits into your nostrils), a simple face mask, a non-rebreathing mask (that prevents you from breathing in the same air again), or a high-flow nasal cannula (which delivers more air).

In very severe cases where other treatment doesn’t work, you may be given extracorporeal membrane oxygenation (a technique to provide oxygen to your blood outside the body).

If you have high levels of carbon dioxide (a waste gas) in your blood and your blood is too acidic (respiratory acidosis), the treatment may be delivered by treating the cause or providing support to help you breathe better.

Patients with severe breathing issues are usually intubated, meaning a tube is inserted into their windpipe to help them breathe. The goals of this kind of support are to correct low oxygen, correct acidity in the blood from respiratory issues, and rest the tired muscles used in breathing.

If you need mechanical assistance to breathe, some common reasons include: lack of breathing leading to respiratory arrest, breathing too quickly (more than 30 breaths per minute), being unconscious or in a coma, tiredness in your respiratory muscles, unstable blood pressure, failing to increase oxygen levels in blood despite receiving supplemental oxygen, and high carbon dioxide levels with low pH in the blood (indicating acidity).

Depending on the situation, doctors will decide whether invasive or noninvasive (doesn’t require an incision or penetration into the body) support is suitable. For instance, noninvasive ventilation (NIV), such as ventilation provided through a mask, is preferred in certain situations, such as in long-term blockage of the airways (chronic obstructive pulmonary disease), fluid accumulation in the lungs due to heart issues (cardiogenic pulmonary edema), and in overweight individuals experiencing breathing difficulties during sleep (obesity hypoventilation syndrome).

When a doctor is diagnosing respiratory failure, they need to consider a wide range of conditions that might be causing the problem. This includes but is not limited to:

Acute respiratory distress syndrome
Aspiration pneumonia or pneumonitis
Asthma
Atelectasis (Collapsed lung)
Bacterial pneumonia
Bronchitis
Cardiogenic pulmonary edema
Cardiogenic shock
Central sleep apnea
Cervical cord injury
Cor pulmonale (Right-sided heart failure)
Diaphragmatic paralysis
Distributive shock
Drug overdose
Emphysema
Fat embolism
Granulomatous lung disease
Idiopathic pulmonary arterial hypertension
Kyphoscoliosis (Abnormal curvature of the spine)
Myxedema (Severe hypothyroidism)
Myocardial infarction (Heart attack)
Neurogenic pulmonary edema
Obesity hypoventilation syndrome
Obstructive shock
Obstructive sleep apnea
Pleural effusion (Fluid in the chest cavity)
Pneumothorax (Collapsed lung)
Pulmonary fibrosis
Restrictive lung disease
Pneumoconiosis (Lung disease due to dust inhalation)
Primary muscle disorders
Pulmonary arterial hypertension
Pulmonary embolism
Viral pneumonia

It’s important that the doctor checks for all of these conditions during the diagnostic process for respiratory failure.

What to expect with Respiratory Failure in Adults

Respiratory failure is a complex health issue that can arise from many different medical conditions, which can make predicting the course of the disease difficult. In 2017, in the United States, about 12% of the patients hospitalized due to respiratory failure did not survive. This percentage is based on a broad definition of respiratory failure that includes all related diagnosis codes.

When looking at specific respiratory conditions that require the use of a life-support machine for breathing (known as intubation with mechanical ventilation), the survival rates were different. For severe cases of asthma, about 9.8% of the patients didn’t make it. For people with a severe flare-up of chronic obstructive pulmonary disease (a type of chronic lung disease), the mortality rate was higher, at 38.3%. For pneumonia (an infection that inflames the air sacs in one or both lungs), the figure was even higher, at 48.4%. And for those with acute respiratory distress syndrome (a severe lung condition that causes low oxygen levels in the blood), almost half did not survive, with a mortality rate of 44.3%.

Possible Complications When Diagnosed with Respiratory Failure in Adults

Respiratory failure is tied to different complications that are related to the lungs as well as other areas of the body. This is particularly true when the failure happens suddenly. Complications affecting the lungs include conditions like an abnormal connection between the bronchial tube and the pleural space outside it, infection acquired in a hospital setting, air leak in the chest cavity, blockage in the lung’s main artery, and scarring of the lungs. Complications that affect other areas include issues with acid and base balance in the body, reduced heart performance, bleeding in the stomach and intestines, liver failure, paralysis of the intestines, infections, increased pressure inside the skull, undernutrition, air in the abdomen, kidney failure, and low platelets in the blood. Health professionals need to recognize all these complications, then aim to prevent or correctly treat them.

Complications of Respiratory Failure:

Lung-related complications:

An abnormal link between the airway and space outside the lungs
Hospital-acquired infections
Chest cavity air leak
Blockage in lung artery
Scarring of lungs

Complications in other areas of the body:

Issues with body’s acid and base balance
Diminished heart function
Bleeding in digestive tract
Liver failure
Paralysis of the intestines
Infections
Raised pressure inside the skull
Malnutrition
Abdominal air
Kidney failure
Low blood platelets

Preventing Respiratory Failure in Adults

It’s important for patients to understand the signs of respiratory failure – when your body isn’t getting enough oxygen or isn’t able to get rid of carbon dioxide. It’s equally critical to use any prescribed devices and medication correctly and consistently. There are also lifestyle factors that can affect your health, and understanding these will help avoid worsening your condition. For example, there are proven ways to prevent acute episodes of chronic obstructive pulmonary disease (COPD) – a type of lung disease that makes it hard to breathe. These include taking prescribed medicine correctly, following a lung rehabilitation program, quitting smoking, and staying up-to-date with certain vaccines (like influenza and pneumococcal).

However, please bear in mind that not all causes of respiratory failure can be avoided. If you start noticing symptoms, it’s crucial that you get medical help right away. This will allow for early treatment, which can greatly improve your health outcome.

Frequently asked questions

The prognosis for respiratory failure in adults can vary depending on the specific respiratory condition and its severity. However, based on the provided information, the mortality rates for certain respiratory conditions requiring mechanical ventilation are as follows: - Severe asthma: Approximately 9.8% mortality rate - Severe flare-up of chronic obstructive pulmonary disease (COPD): 38.3% mortality rate - Pneumonia: 48.4% mortality rate - Acute respiratory distress syndrome (ARDS): 44.3% mortality rate

Respiratory failure in adults can be caused by various factors, including acute myocardial infarction, acute respiratory distress syndrome, COVID-19, and acute exacerbation of chronic obstructive pulmonary disease. Other potential causes include incorrect use of inhalers, exposure to environmental triggers, high blood pressure, chronic cough, certain medications, lifestyle factors (such as alcohol consumption and sedentary behavior), occupational exposure to lung diseases, family history of genetic or infectious conditions, and smoking or exposure to second-hand smoke.

The signs and symptoms of respiratory failure in adults can vary, but some common indicators include: - Difficulty breathing: Adults experiencing respiratory failure may struggle to breathe properly, feeling short of breath or unable to take in enough air. - Coughing: Persistent coughing can be a symptom of respiratory failure, especially if it is accompanied by other respiratory issues. - Coughing up blood: Blood in the cough can be a concerning sign and should be evaluated by a doctor. - Excessive mucus production: Respiratory failure can cause the production of large amounts of mucus, leading to congestion and difficulty clearing the airways. - Wheezing: Wheezing, a high-pitched whistling sound when breathing, can be a sign of respiratory distress. - Chest pain: Some adults with respiratory failure may experience chest pain, which can be sharp, dull, or aching in nature. - Decreased appetite: Respiratory failure can cause a loss of appetite, leading to unintended weight loss. - Heartburn: Chronic heartburn or acid reflux can be a symptom of respiratory failure, especially if it is accompanied by other respiratory issues. - Fever: A fever can indicate an underlying infection or inflammation in the respiratory system. - Loss of sense of smell: In some cases, respiratory failure may be associated with a loss of the sense of smell, particularly in high-risk groups such as older patients, men, or extremely overweight individuals. It is important to note that these signs and symptoms can vary depending on the underlying cause of respiratory failure. Therefore, a thorough assessment by a doctor is necessary to determine the specific cause and appropriate treatment.

To properly diagnose respiratory failure in adults, doctors may order the following tests: 1. Arterial Blood Gas (ABG) test: Measures the acid-base levels, oxygen levels, and carbon dioxide levels in the blood. 2. Capnometry: Measures the amount of carbon dioxide exhaled and compares it to the levels in arterial blood. 3. Radiography: Different imaging techniques like X-rays, CT scans, MRI, nuclear medicine, angiography, and ultrasonography can visualize the state of the lungs. 4. Pulse Oximetry: A non-invasive test that estimates the level of oxygen in the blood by shining light through the skin. 5. Ultrasonography: The BLUE-protocol is an ultrasound method used to diagnose acute respiratory failure at the bedside. 6. Other techniques like bronchoscopy, echocardiography, sleep studies, and lung function tests may also be useful in diagnosing respiratory failure.

The doctor needs to rule out the following conditions when diagnosing Respiratory Failure in Adults: - Acute respiratory distress syndrome - Aspiration pneumonia or pneumonitis - Asthma - Atelectasis (Collapsed lung) - Bacterial pneumonia - Bronchitis - Cardiogenic pulmonary edema - Cardiogenic shock - Central sleep apnea - Cervical cord injury - Cor pulmonale (Right-sided heart failure) - Diaphragmatic paralysis - Distributive shock - Drug overdose - Emphysema - Fat embolism - Granulomatous lung disease - Idiopathic pulmonary arterial hypertension - Kyphoscoliosis (Abnormal curvature of the spine) - Myxedema (Severe hypothyroidism) - Myocardial infarction (Heart attack) - Neurogenic pulmonary edema - Obesity hypoventilation syndrome - Obstructive shock - Obstructive sleep apnea - Pleural effusion (Fluid in the chest cavity) - Pneumothorax (Collapsed lung) - Pulmonary fibrosis - Restrictive lung disease - Pneumoconiosis (Lung disease due to dust inhalation) - Primary muscle disorders - Pulmonary arterial hypertension - Pulmonary embolism - Viral pneumonia

The side effects when treating Respiratory Failure in adults can include complications in both the lungs and other areas of the body. Some of the specific side effects include: Lung-related complications: - Abnormal link between the airway and space outside the lungs - Hospital-acquired infections - Chest cavity air leak - Blockage in lung artery - Scarring of lungs Complications in other areas of the body: - Issues with the body's acid and base balance - Diminished heart function - Bleeding in the digestive tract - Liver failure - Paralysis of the intestines - Infections - Raised pressure inside the skull - Malnutrition - Abdominal air - Kidney failure - Low blood platelets

A pulmonologist.

In 2017, the United States recorded an occurrence rate of 1,275 cases per 100,000 adults.

Respiratory failure in adults is treated by addressing the underlying cause and providing support to improve breathing. Doctors will ensure clear airways, maintain oxygen supply, ventilate properly, and correct any imbalances in blood gases. Low oxygen levels can be corrected by adjusting oxygen concentrations to safe levels. Oxygen can be delivered through various methods such as nasal cannula, face mask, or high-flow nasal cannula. In severe cases, extracorporeal membrane oxygenation may be used. High levels of carbon dioxide and respiratory acidosis can be treated by addressing the cause or providing support. Intubation may be necessary to assist with breathing and correct oxygen levels and acidity in the blood. The choice between invasive and noninvasive support depends on the specific situation. Noninvasive ventilation, such as through a mask, may be preferred in certain conditions.

Respiratory failure in adults is a condition where the respiratory system is unable to provide enough oxygen to the body (Type 1) or remove enough carbon dioxide from the body (Type 2). It can be acute, chronic, or acute on chronic, and if left untreated, it can lead to severe outcomes such as difficulty breathing, coma, and death.