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Respiratory Failure
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Lungs Breathing

Respiratory Failure

Respiratory failure occurs when the blood lacks sufficient oxygen or contains excess carbon dioxide, often requiring medical intervention to support breathing.

What is respiratory failure?

Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems. When you breathe, your lungs take in oxygen and remove carbon dioxide; having too much carbon dioxide in your blood can harm your organs.

What causes respiratory failure?

Conditions that affect the muscles, nerves, bones, or tissues that support breathing, or the lungs directly, can cause respiratory failure:

  • Diseases that affect the lungs, such as COPD, cystic fibrosis, pneumonia, pulmonary embolism, and COVID-19.
  • Conditions that affect the nerves and muscles that control breathing, such as ALS, muscular dystrophy, spinal cord injuries, and stroke.
  • Problems with the spine, such as scoliosis.
  • Damage to the tissues and ribs around the lungs, such as chest injuries.
  • Drug or alcohol overdose.
  • Inhalation injuries, such as from smoke or harmful fumes.

What are the symptoms of respiratory failure?

Symptoms depend on the cause and gas levels in the blood:

  • Low oxygen: Shortness of breath, air hunger, and bluish color on skin, lips, or fingernails.
  • High carbon dioxide: Rapid breathing and confusion.
  • Severe cases: Extreme sleepiness, loss of consciousness, or arrhythmia (irregular heartbeat).

How is respiratory failure diagnosed?

Diagnosis is based on medical history, physical exams, and diagnostic tests:

  • Pulse oximetry: A sensor that measures oxygen levels in the blood.
  • Arterial blood gas test: Measures oxygen and carbon dioxide levels in a blood sample taken from an artery.
  • Imaging/Heart tests: Chest x-rays or an EKG to detect heart electrical activity.

What are the treatments for respiratory failure?

Treatment aims to restore oxygen levels, remove carbon dioxide, and address the underlying cause. Options include:

  • Oxygen therapy: Delivered via nasal cannula or mask.
  • Tracheostomy: A surgically-made hole in the windpipe to assist breathing.
  • Ventilator: A machine that blows air into the lungs.
  • Other breathing treatments: Such as noninvasive positive pressure ventilation (NPPV) or specialized beds.
  • Fluids: Administered via IV to improve blood flow and provide nutrition.
  • Medicines: For discomfort or to treat the underlying cause.

Living with chronic respiratory failure may cause fear, anxiety, depression, and stress; talk therapy, medicines, and support groups can help.

Frequently Asked Questions

The reversibility depends entirely on the underlying cause. If respiratory failure is triggered by an acute event like a drug overdose, a severe asthma attack, or pneumonia, it can often be fully reversed with timely medical intervention and treatment of the primary condition. However, if it results from chronic progressive diseases like advanced COPD, ALS, or severe lung fibrosis, the condition may be permanent, requiring long-term support such as home oxygen therapy or mechanical ventilation.
Look for signs of severe hypoxia or hypercapnia, such as confusion, extreme lethargy, or difficulty staying awake, which indicate the brain is not receiving enough oxygen or is overwhelmed by carbon dioxide. Additionally, a bluish tint to the lips, fingernails, or skin (cyanosis) and an irregular heartbeat are critical red flags. If a patient is struggling to speak in full sentences or is using their neck and chest muscles to breathe, call emergency services immediately.
The decision is based on the patient's blood gas levels and their ability to maintain adequate breathing on their own. If a patient has low oxygen but is breathing adequately on their own, supplemental oxygen via a mask or nasal cannula may suffice. If the patient has high carbon dioxide levels (hypercapnia) or is too exhausted to breathe effectively, non-invasive ventilation (like BiPAP) or invasive mechanical ventilation (a tube in the airway) is required to take over the work of breathing and prevent organ damage.
Pulse oximetry is a non-invasive tool that measures the percentage of oxygen saturation in the blood. For patients with chronic respiratory conditions, it helps track trends and detect early declines in oxygen levels before they become symptomatic. However, it does not measure carbon dioxide levels, so a normal oxygen reading does not rule out respiratory failure caused by CO2 retention. Patients should follow their provider's specific target ranges and report any consistent drops or new symptoms like morning headaches or confusion.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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