Are you having trouble breathing? Let's talk about respiratory failure.

Do you sometimes feel like you're having a hard time breathing? Or do you feel like you can't breathe? It's not a good idea to just ignore these things. Because, this could be a sign of a serious condition called Respiratory Failure . Today, we'll talk about this in a simple way that you can understand. This could be a medical emergency, so it's important to be aware of this.

How do we breathe? What happens if this doesn't work properly?

Think about it, oxygen is to our bodies like gasoline to a car, or like the fuel we need to run our lives. When we breathe in, this precious gas called oxygen goes into our lungs. To be precise, this oxygen goes into the tiny air sacs in the lungs, called alveoli . It's like a bus pulling up to a bus stop.

From there, the blood "carries" this oxygen to all parts of the body, including our brain, heart, muscles, and other organs. If this oxygen doesn't get to those places, our body's cells won't be able to function, like a car without fuel.

Now, after the oxygen has been "delivered" to those places, the blood cells, as they return, collect carbon dioxide, a gas that is useless to the body and a waste product. This is like taking groceries to a store and returning empty boxes. If this carbon dioxide accumulates in the body, that is also a problem. Because then there is not enough room for the blood to carry new oxygen. So, this carbon dioxide comes back to the lungs and is expelled from the body when we exhale. That is when we have room to take in some new oxygen again.

If any part of this entire process goes wrong, our body's tissues don't get enough oxygen. That's what we call Respiratory Failure .

Are there types of respiratory failure?

Yes, there are several types of this condition, depending on how it occurs and what it mainly affects. Sometimes it can occur suddenly (acute) , and other times it can develop gradually over time (chronic) . The two main types are:

1. Hypoxemic Respiratory Failure - Type 1

Simply put, this is a condition where your blood has low levels of oxygen (`hypoxemia`) . This happens when you breathe but your blood doesn't get enough oxygen. Heart disease and lung disease are the main causes of this. Some people also call it hypoxic respiratory failure.

2. Hypercapnic Respiratory Failure - Type 2

This is when the amount of carbon dioxide (CO2) in your blood increases . When our bodies can't get rid of the waste product called carbon dioxide properly, CO2 builds up in the blood. Then, as mentioned earlier, there's no room for oxygen in the blood. This condition can be caused by diseases of the heart, lungs, muscles, and nervous system (brain and spinal cord). Some medications can also cause this.

There are other types:

• Perioperative Respiratory Failure (Type 3): This can occur during surgery. The anesthesia used during surgery can sometimes make breathing difficult. Also, the air sacs in the lungs can collapse (atelectasis), preventing oxygen from reaching the blood.
• Respiratory Failure Due to Shock (Type 4): Shock is a serious condition in which there is a sudden drop in blood pressure and problems such as pulmonary edema. This can also cause respiratory failure. Shock can be caused by things like sepsis ( a severe infection that spreads throughout the body), sudden heart attacks , and excessive bleeding.

What are the symptoms of this condition?

Symptoms of respiratory failure can vary depending on the cause. However, there are some common symptoms:

• Difficulty breathing or feeling short of breath (dyspnea).
• Rapid breathing (tachypnea).
• Feeling very tired (fatigue).
• Feeling like your heart is beating fast or your heartbeat is irregular.
• Coughing up mucus or blood (hemoptysis).
• Excessive sweating.
• Restlessness, agitation.
• Pale skin.
• Blue discoloration of the skin, lips, or fingernails (cyanosis) - This is a serious sign of lack of oxygen.
• Headache .
• Blurred vision.
• Anxiety, confusion, inability to think clearly.
• Changes in behavior, not being as usual.

Important: If you have any of these symptoms, you should seek medical advice immediately , as this could be an emergency.

What are the causes of respiratory failure?

Simply put, this condition occurs when our body's ability to take in oxygen and expel carbon dioxide is disrupted for some reason. Things that can affect this include:

• Lack of adequate airflow or decreased blood supply to the lungs.
• Obstruction, scarring, or fluid buildup in the lungs.
• Inability to breathe properly or deeply. This can be caused by diseases that affect the lungs, problems with the nerves or muscles that help you breathe, or injuries to the chest.
• Abnormalities in the flow of blood through the heart.

Who is at higher risk? (Risk Factors)

Some people are at higher risk of developing respiratory failure. They are:

• People with lung diseases: For example, diseases such as acute respiratory distress syndrome (ARDS) , chronic obstructive pulmonary disease (COPD) , pneumonia , asthma , cystic fibrosis , pulmonary edema (fluid in the lungs) , pulmonary embolism (blood clot in a lung tube) , and pulmonary fibrosis (scarring of the lungs) .
• People with heart or circulatory system diseases: such as heart attack , congenital heart disease , heart failure , and shock .
• People with diseases that affect the nerves and muscles that help with breathing: conditions such as muscular dystrophy , amyotrophic lateral sclerosis (ALS) , severe scoliosis (curvature of the spine) , and Guillain-Barré syndrome .
• Injuries to the chest, spinal cord, or brain (including stroke).
• Smoking or exposure to other lung irritants: chemical fumes, dust, air pollution (such as the heavy vehicle emissions on our roads, factory fumes, and dust from construction sites), and asbestos.
• Surgeries that require anesthesia.
• Drug use or excessive alcohol consumption.
• Age: Newborns (especially those born with low growth) and adults over 65 years of age are at higher risk.

How do doctors diagnose this?

A doctor will check for respiratory insufficiency by checking the amount of oxygen and carbon dioxide in your blood . They will also check your blood pressure and use a small clip-on device (called a `pulse oximeter` or `pulse ox`) to check the oxygen level in your blood. They will also listen to your heart and lungs and examine you. If this condition is suspected, they may do several other tests.

What are those tests?

• Pulse oximetry: This involves placing a sensor on your finger to measure the amount of oxygen in your blood. This is usually done when you see a doctor.
• Arterial Blood Gas (ABG) test: A small sample of blood is taken with a needle from the wrist, upper arm, or groin and the oxygen and carbon dioxide levels are measured. This can provide very accurate information.
• Pulmonary Function Tests (PFT): In this test, you are asked to breathe in and out through a mouthpiece connected to a machine. This can check how well your lungs are working.
• Imaging tests: X-rays and CT scans take pictures of the inside of the body. While these cannot directly diagnose respiratory failure, they can help determine what is causing it.
• Electrocardiogram (EKG): This measures how well the heart is working. If the doctor thinks the problem is due to heart disease, he or she will order an EKG.

How is this treated?

The treatment for respiratory failure depends on its severity and cause . The main goals of treatment are to treat the underlying cause, give you more oxygen, or use a breathing machine (`mechanical ventilation`) until you can breathe on your own again.

Acute respiratory failure is an emergency and needs to be treated immediately. However, mild, long-term (chronic) respiratory failure can sometimes be treated at home by controlling the underlying condition.

What are the specific treatments?

• Mechanical ventilation: This involves connecting you to a breathing machine and a tube inserted into your airway, which inhales and exhales air into your lungs.
• Extracorporeal Membrane Oxygenation (ECMO): This is a slightly more complex treatment. It involves using a bypass machine to remove blood from the body, add oxygen to it, remove carbon dioxide, and then re-enter the body.
• Oxygen therapy: A machine delivers extra oxygen through a breathing mask or a small tube (cannula) placed in the nose. This can be done in the hospital or at home.
• Fluids: Fluids are given intravenously (IV - directly into a vein). This improves blood circulation in the body and helps carry more oxygen to the tissues.
• Treating underlying medical conditions: Depending on the cause of respiratory failure, the doctor may recommend other medications or treatments.

Is there a way to prevent this?

Respiratory failure cannot always be prevented. However, you can reduce your risk of developing chronic respiratory failure by managing any underlying heart, lung, or nervous system conditions you may have. If you have a risk factor for this condition, talk to your doctor about ways to reduce your risk.

Can respiratory failure be cured?

This is a very serious condition. Most people recover from it. It depends on the cause of the disease, its severity, and how quickly it is treated.

Although many causes of acute respiratory failure can be treated, it can be fatal if not treated quickly. About a third of people hospitalized with acute respiratory failure die. Chronic respiratory failure is usually caused by a disease that gets worse over time.

When should I see a doctor?

If you have a chronic condition that puts you at risk for respiratory failure, talk to your doctor. He or she can tell you what symptoms of respiratory failure to watch out for and how to manage your condition.

When should I go to the Emergency Department (ETU) ?

If you have symptoms of respiratory failure, go to the nearest emergency room immediately, or call 911. This can be fatal if not treated quickly.

What should I ask my doctor?

It may be helpful to ask your doctor questions like these:

• What treatment options do I have?
• What is the reason for this?
• How should I use my medications?
• How should I use this device (e.g., oxygen machine)? Can you show me how?
• When can I expect to get well?
• When should I come see you again?

Take-Home Message

Respiratory failure is a serious, sometimes fatal condition. If you think you are having acute respiratory failure, please call 911 immediately or seek emergency medical attention. If you have chronic respiratory failure, or if you have conditions that increase your risk of it, talk to your doctor about proper treatment. He or she can explain what your treatment options are and what to expect based on your condition. Take care of your breathing, because it is your life!

` Respiratory insufficiency, difficulty breathing, oxygen, carbon dioxide, lungs, emergency care, ARDS, COPD