When a person has acute respiratory failure, the usual exchange between oxygen and carbon dioxide in the lungs does not occur. As a result, enough oxygen cannot reach the heart, brain, or the rest of the body.

This can cause symptoms such as shortness of breath, a bluish tint in the face and lips, and confusion.

Acute respiratory failure has many possible causes. The cause may be acute, including pneumonia, or chronic, such as amyotrophic lateral sclerosis (ALS).

Acute respiratory failure is a serious illness. If a person thinks they or someone else has it, they should seek immediate medical attention.

A doctor can evaluate the person’s breathing, the amount of oxygen and carbon dioxide in the blood, and the overall symptoms to determine appropriate treatments.


Acute respiratory failure
The respiratory system cannot perform its usual functions when the lungs don’t receive enough oxygen.

Acute respiratory failure usually stems from difficulty getting enough oxygen to the lungs, problems removing carbon dioxide from the lungs, or both.

As a result, the respiratory system cannot perform its usual functions.

Potential causes include:

Determining the cause of acute respiratory failure helps a doctor determine the most appropriate treatments.


Doctors typically classify acute respiratory failure as one of four types:

Type 1

Doctors call this hypoxemic respiratory failure. It means that a person is not exchanging oxygen properly in their lungs. This may be due to swelling or damage to the lungs.

A person with type 1 acute respiratory failure has very low oxygen levels.

Type 2

In a person with type 2 acute respiratory failure, the lungs are not removing enough carbon dioxide, which is a gas and a waste product. The lungs usually exchange carbon dioxide for fresh oxygen.

This type of respiratory failure causes carbon dioxide levels to be high. It may result from a drug overdose that has caused a person to breathe too slowly, or because of lung damage from smoking, which causes COPD.

Type 3

Doctors refer to this as perioperative respiratory failure. It occurs when a person has had surgery, and the small airways in the lungs have closed in greater numbers.

Factors such as pain or stomach surgery, which places higher pressure on the lungs, can also contribute to this type of respiratory failure.

Type 4

Type 4 respiratory failure is a shock state. It means that the body cannot adequately provide oxygen and maintain blood pressure on its own.

This can result from serious illness or injury, such as when a person loses too much blood.


A doctor will take into account a person’s symptoms, as well as their laboratory and imaging results when diagnosing the cause of acute respiratory failure.

They may use an arterial blood gas, or ABG, test. This involves drawing blood from an artery and testing the levels of oxygen and carbon dioxide.

A doctor can use ABG results to determine if a person has type 1 or type 2 respiratory failure.


Acute respiratory failure tired
Appearing very sleepy is a symptom of acute respiratory failure.

Symptoms may include changes in a person’s appearance, ease of breathing, and how they act.

Examples of symptoms include:

  • appearing very sleepy
  • a blue tinge to a person’s fingernails, lips, or skin
  • confusion
  • irregular heart rhythms
  • passing out
  • rapid breathing
  • shortness of breath

Generally, the symptoms of acute respiratory failure depend on the underlying cause.

Potential complications

Acute respiratory failure can be fatal.

According to a presentation on the website of the American Thoracic Society, about 360,000 people experience acute respiratory failure each year in the United States. Approximately 36 percent of these individuals die during a hospital stay.

This figure may be higher, depending on the underlying cause. For example, authors of a study in the European Respiratory Review estimate that people in the hospital with the most severe form of ARDS have a 42 percent mortality rate.

An episode of acute respiratory failure can cause damage to the lungs that requires a person to carry oxygen with them at all times. Some people require a tracheotomy, which creates a hole in the neck below the vocal cords to assist in breathing in the long term.


Treatments for acute respiratory failure depend on the underlying cause.

For example, respiratory failure from scoliosis may require surgical correction of the spine to enable the lungs and heart to work more efficiently.

A person with acute respiratory failure will typically require extra oxygen. This may come in the form of mechanical ventilation, which involves a doctor inserting a plastic tube down a person’s windpipe. The tube sits below the vocal cords and can deliver oxygen and pressure to inflate the lungs more effectively.

Doctors typically use this method of delivering oxygen until they can slow, resolve, or reverse the underlying cause of respiratory failure.

Other acute respiratory failure treatment strategies include:

  • medications, such as antibiotics to treat infections and diuretics to reduce the mount of fluid in the lungs and body
  • chest wall oscillation or vibration to loosen mucus in the lungs
  • prone ventilation, which involves placing a person on their stomach and providing oxygen through a ventilator.
  • extracorporeal membrane oxygenation, which involves using a cardiopulmonary bypass machine to take blood from the body and provide oxygen to reduce the workload on the heart and lungs

A doctor may also prescribe medications to sedate a patient, making breathing with the ventilator easier to tolerate.

Because acute respiratory failure is such a serious condition, treatments can take time and may be intensive.


Acute respiratory failure smoking
Refraining from smoking cigarettes can help protect the lungs.

Not all causes of acute respiratory failure, such as trauma, are preventable.

However, in the case of pneumonia and some other airway-related illnesses, a person can take some steps to protect their lungs.

These include:

  • refraining from smoking cigarettes, which can damage the lungs
  • seeing a doctor at early signs of a bacterial infection, such as a fever, cough, and high mucus production
  • taking all medications a doctor prescribes to keep the heart and lungs healthy
  • if necessary, using assistive devices to maintain oxygen levels, such as continuous positive airway pressure masks, which a person can wear at home
  • engaging in appropriate levels of physical activity to enhance lung function

If a person has a history of lung problems and hospitalization, they should talk to their doctor about strategies to enhance their overall health.


Acute respiratory failure is a serious medical condition that has many possible underlying causes.

Symptoms include confusion, rapid breathing, and shortness of breath.

Seek immediate medical attention at the first signs of respiratory failure to prevent the illness from worsening.