What are the symptoms of respiratory failure?

Written by Han Shun Li
Pulmonology
Updated on September 03, 2024
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Respiratory failure is a common and serious condition in clinical settings, often categorized as an acute and critical illness. Simply put, respiratory failure occurs when respiratory function is extremely poor. It is caused by severe impairment of pulmonary ventilation and gas exchange due to various reasons. Even at rest, sufficient gas exchange cannot be maintained, leading to serious hypoxemia or concurrent hypercapnia. Clinically, this often presents with severe breathing difficulties, hypoxia, cyanosis, and requires immediate intervention to prevent potentially life-threatening complications.

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How to treat respiratory failure?

Treatment of patients with respiratory failure is primarily medical, focusing on suppressing or relieving the causes and triggers of respiratory failure, improving lung ventilation and gas exchange as much as possible, and treating and improving the function and condition of various vital organs. First, it is important to actively treat the primary disease causing respiratory failure. If there is a concurrent bacterial infection, sensitive antibiotics should be used, and triggers should be removed as much as possible. Simultaneously, maintaining airway patency and effective ventilation volume is necessary, which can involve administering bronchodilators and expectorants such as salbutamol, terbutaline sulfate, acetylcysteine, and ambroxol. When necessary, corticosteroids can be administered intravenously. If internal medicine treatment does not improve symptoms, tracheotomy and mechanical ventilation may be necessary to assist breathing. (Medications should be taken under the guidance of a physician, based on the actual situation.)

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Causes of Respiratory Failure

Respiratory failure is relatively common in clinical practice and is frequently seen in critical respiratory conditions. The causes of respiratory failure most often arise from diseases of the respiratory and circulatory systems, such as chronic obstructive pulmonary disease, acute exacerbation of asthma, severe pneumonia, severe pulmonary tuberculosis, diffuse pulmonary fibrosis, pulmonary edema, pneumoconiosis, pulmonary embolism, various causes of heart failure, pulmonary hypertension, severe pneumothorax, and substantial pleural effusion, among others. These can all lead to respiratory failure. Therefore, if respiratory distress occurs clinically and respiratory failure is suspected, it is crucial to conduct prompt examinations and actively manage the condition.

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The earliest clinical symptoms of respiratory failure

The clinical symptoms of respiratory failure mainly manifest as hypoxemia and carbon dioxide retention. Looking at their clinical manifestations, mild hypoxia may not show any clinical symptoms. As the severity of the disease increases, there can be signs of increased respiratory drive, such as rapid breathing or difficulty breathing, along with symptoms of sympathetic nervous system activation, such as anxiety and sweating. Hypoxemia can cause dilation of peripheral arteries and constriction of veins, leading to an increased heart rate, or even severe arrhythmias. Furthermore, considering the clinical manifestations of carbon dioxide retention, they are directly related to the levels of carbon dioxide in the body, mainly depending on the rate of occurrence. Clinically, this primarily affects myocardial contractility, the contractile ability of respiratory muscles, and increases in intracranial blood flow. In mild to moderate cases, it can stimulate the respiratory center causing increased and shallow breathing, but in severe cases, it may suppress the respiratory center.

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Classification of Causes of Respiratory Failure

Respiratory failure, if categorized by its cause, can be divided into pump failure and lung failure. Pump failure refers to the failure of the respiratory pump, which comprises the central nervous system that drives or regulates respiratory movement, the peripheral nervous system, neuromuscular tissues, and the thoracic cage, collectively known as the respiratory pump. Respiratory failure caused by dysfunction of these components is called pump failure. Another type is lung failure, which results from airway obstruction, pulmonary tissue and vascular pathology, and is termed lung failure. Lung failure can lead to type I or type II respiratory failure, whereas pump failure typically presents as type II respiratory failure.

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Precursors of respiratory failure

Respiratory failure can be a very acute condition, or it may evolve gradually due to chronic diseases. The basic precursors of respiratory failure generally include hypoxia or hypercapnia. In the early stages of hypoxia, patients may experience excitement or irritability, characterized by rapid breathing and possibly sweating due to the effort of breathing. Symptoms include accelerated breathing and hypoxia; the patient’s lips may also turn blue. If the level of carbon dioxide increases, once past the initial period of excitement and as the hypoxia worsens, the person may become listless. Gradually, their consciousness may become unclear, manifesting as drowsiness or possibly even coma.