Is respiratory failure reversible?

Written by Wang Ji Zhong
Internal Medicine
Updated on June 29, 2025
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Respiratory failure has a high mortality rate and can easily lead to the impairment of multiple organ functions, seriously endangering the life of the patient. The mortality rate largely depends on whether the condition can be diagnosed and treated early. In cases of respiratory failure, if the progression is rapid and the body does not have particularly good metabolism, it can easily affect life. Acute respiratory failure is generally curable; it often occurs because carbon dioxide retention leads to hypoxia in the body. At this time, providing high-flow oxygen can effectively alleviate the symptoms and additional appropriate medication can be administered based on the condition to facilitate a return to normal.

However, chronic respiratory failure caused by conditions like chronic bronchitis and pulmonary heart disease are major causes of respiratory failure. In such cases, it is only possible to slow the progression of the disease; returning to a normal state is rather unlikely. Therefore, patients with chronic respiratory failure generally need long-term home oxygen therapy to ensure that the hypoxic condition can be improved.

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Written by Peng Miao Yun
Internal Medicine
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How to administer oxygen for respiratory failure

If patients with respiratory failure undergo oxygen therapy, it is necessary to choose different therapy plans based on the type of respiratory failure. In the case of Type I respiratory failure, there is simply a lack of oxygen. For Type II respiratory failure, there is not only a lack of oxygen but also an accumulation of carbon dioxide. Therefore, for Type I respiratory failure, the oxygen flow can be higher, over five liters per minute, and the patient can continuously receive oxygen without causing significant side effects. However, for Type II respiratory failure, it is essential to control the oxygen flow at a low rate, under three liters per minute, otherwise, it may lead to other complications.

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Written by Wei Shi Liang
Intensive Care Unit
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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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Written by Peng Miao Yun
Internal Medicine
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Principles of oxygen therapy for respiratory failure

Patients with respiratory failure undergoing oxygen therapy should be treated differently depending on the type of respiratory failure. If it is Type I respiratory failure, it is simply hypoxia without accompanying carbon dioxide retention. Our oxygenation principle can provide slightly higher oxygen flow, with an oxygen flow rate exceeding 5 liters per minute. However, if it is Type II respiratory failure, which comes with severe carbon dioxide retention, it requires continuous low-flow oxygenation. This type of respiratory failure is often caused by chronic pulmonary diseases. Because if high-flow oxygen is provided, the peripheral chemoreceptors' response to hypoxia will decrease in the short term, which will exacerbate respiratory suppression, leading to increased carbon dioxide retention and worsening the condition. Therefore, for Type II respiratory failure, low-flow continuous oxygen should be provided, with an oxygen flow rate controlled below 3 liters per minute.

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Written by Peng Miao Yun
Internal Medicine
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Respiratory failure classified by etiology

Respiratory failure can be classified according to its causes into four types. The first type involves diseases of the airway such as bronchial inflammation, bronchiectasis, and foreign body obstruction, leading to insufficient ventilation. The second type is due to lung tissue diseases, such as pneumonia, severe tuberculosis, emphysema, diffuse pulmonary fibrosis, adult respiratory distress syndrome, etc., causing a state of hypoxia and carbon dioxide retention due to ventilatory defects. The third type includes pulmonary vascular diseases, such as pulmonary vascular embolism and pulmonary infarction, which cause part of the venous blood to flow into the pulmonary veins, resulting in hypoxia. The fourth type involves diseases of the thoracic cage such as chest trauma, surgical trauma, pneumothorax, and pleural effusion, which affect daily activities and lung expansion, leading to insufficient lung ventilation and resulting in respiratory failure.

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Written by Li Qiang
Intensive Care Unit
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How to grade respiratory failure

Respiratory failure is generally not graded; instead, it is classified into types. There are two types, Type I and Type II. Type I is characterized by an oxygen tension lower than 60 mmHg, at which point, there is no increase in carbon dioxide, and the carbon dioxide level is normal. Type II respiratory failure is when the oxygen tension is below 60 mmHg, accompanied by an increase in carbon dioxide, which is then termed Type II respiratory failure. Regarding respiratory failure, it is classified by type and not by severity grade. This means that once it meets these criteria, it is referred to as respiratory failure, and at this point, some emergency treatments to improve low oxygen levels are necessary. Therefore, respiratory failure is generally not graded into mild, moderate, or severe degrees. It is only differentiated into different types. Of course, there are different severity levels in respiratory failure, but we generally do not apply a specific degree of severity.