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Respiratory Failure (Acute Vs. Chronic): Causes, Symptoms, Diagnosis - WebMD
Respiratory failure is a condition in which your lungs have a hard time loading your blood with oxygen or removing carbon dioxide.
"Respiratory failure represents the respiratory system's inability to perform gas exchange," explains Aaron Waxman, MD, director of the Pulmonary Vascular Disease Program at Brigham and Women's Hospital in Boston, MA. "Gas exchange is the transit of oxygen into the bloodstream, and carbon dioxide out." It can leave you with low oxygen, high carbon dioxide, or both.
A physical exam and tests to measure oxygen levels in your blood can help your doctor diagnose respiratory failure. (Photo Credit: iStock/Getty Images)
Hypoxemic respiratory failure
If you aren't getting enough oxygen into your blood, your doctor will call this hypoxemic or type 1 respiratory failure. A heart or lung illness is most likely to cause this type of respiratory failure.
Hypercapnic respiratory failure
If you have too much carbon dioxide, it's called hypercapnic, hypercarbic, or type 2 respiratory failure. When your body can't remove carbon dioxide, your blood cells fail to carry oxygen. Heart, lung, muscle, and brain and spinal cord conditions often cause this type of respiratory failure. Some medicines can also trigger it.
Perioperative respiratory failure
This form of respiratory failure happens during surgery when anesthesia stops you from breathing the right way. Your lungs' air sacs may collapse and stop oxygen from entering your blood.
Shock-related respiratory failure
When you go into shock, it can cause health problems that lead to respiratory failure, including low blood pressure and fluid in your lungs.
Acute respiratory failure
Acute respiratory failure comes on quickly, and it's an emergency. "Acute respiratory failure can affect anyone who suffers an acute injury or process that may affect the lungs, heart, or any part of the system that delivers oxygen to the tissues," Waxman says.
Chronic respiratory failure
Respiratory failure can also be chronic, a long-term problem that will need regular care. Chronic respiratory failure happens over time. A worsening health condition, such as one that affects your heart, lungs, brain, spinal cord, or nerves, can raise your chances of getting this type.
Breathing may seem like a simple act, but there are a lot of moving parts. A problem with any one of them can lead to respiratory failure, including:
Acute respiratory failure is more common with an injury to your brain, chest, or lungs. Things such as choking, drowning, or getting hit in the chest could all do it. A sudden, serious illness that affects breathing, such as acute respiratory distress syndrome (ARDS), can also bring it on.
You might have a higher risk of respiratory failure if you:
Your symptoms will depend on the cause and whether you have low oxygen, high carbon dioxide, or both. Some things you may notice are:
Signs of death from respiratory failure
It's an emergency if you have breathing problems, confusion, or if your lips or skin turn blue. Call 911 and go to the hospital right away.
Your doctor will start with a physical exam and ask questions about your health. You'll then get one or both of these tests:
Pulse oximetry. Your doctor puts a small device on your finger or ear to measure your oxygen level.
Arterial blood gas test. This basic blood test measures your levels of oxygen and carbon dioxide.
You may need more tests to look for the cause. That might include things such as a chest X-ray or an EKG, which measures electrical signals in your heart.
Respiratory failure vs. Arrest
Respiratory failure is when there's not enough oxygen or too much carbon dioxide in your body, and respiratory arrest is when you stop breathing and don't get enough oxygen.
Your treatment might include:
Oxygen therapy. You breathe in oxygen, through either a mask or a thin tube with two prongs that sit just inside your nose. You can get a portable oxygen tank so you can still go out and about with it.
Ventilator. You might need one of these breathing machines if oxygen therapy isn't enough or if you can't breathe on your own. They blow air into your lungs to help you get the oxygen you need without having to work so hard for it. They also help lower carbon dioxide levels.
There are a few types. With smaller, simpler ones, you wear a mask over your nose or mouth. A CPAP machine, used for sleep apnea, is one example.
For a more severe problem, you might need a breathing tube that goes down your throat.
Tracheostomy. This is surgery in which your doctor makes an opening in your neck and windpipe to put in a small tube. It's called a trach tube and can make breathing easier. You may also get this if you need a ventilator for more than a week or two. The ventilator connects directly to the trach tube.
Treating the cause. You might need care for the condition that caused your respiratory failure, too. That could mean things such as:
Your treatment will depend on the cause and whether your respiratory failure is chronic or acute. Acute and chronic cases aren't treated the same way, but the ideas are similar:
Acute. You'll go to an ER, but if your treatment there doesn't solve the problem, you may need to stay overnight in the hospital. For severe symptoms, you may need to go to the intensive care unit (ICU). You may get oxygen therapy. And you may need a ventilator until you can breathe on your own. You'll also get medicine and fluids to ease your symptoms and treat the cause of your respiratory failure.
Chronic. You'll get ongoing care in your home, which typically includes medication you take every day — either inhaled medicine or drugs you take by mouth. In severe cases, you might need oxygen therapy.
Because respiratory failure can make it harder for you to sleep, you may also need extra help at night. That could mean one of the smaller ventilators, such as a CPAP machine, to get more air into your lungs. You may also need a special bed that rocks back and forth to help you breathe better. For more serious cases, you'll need a ventilator.
You may not be able to stop respiratory failure from happening, but you can lower your chances by controlling heart, lung, brain, spinal cord, or nerve conditions.
If you have acute respiratory failure, treatment right away can help get you back to your normal activities. With chronic respiratory failure, it's important to follow your doctor's advice about ongoing care. Know what your symptoms mean and when you might need to call your doctor.
Respiratory failure is serious, but many things can affect your outcome, including what's causing your condition.
Respiratory failure happens when your lungs can't bring in enough oxygen or can't remove enough carbon dioxide, which can make you feel short of breath, confused, or even cause you to pass out. There are different types depending on whether oxygen is too low, carbon dioxide is too high, or both. It can come on suddenly (acute) or form over time (chronic), and causes range from lung diseases and chest injuries to brain, nerve, or muscle problems. Treatment depends on the type and cause and may include oxygen therapy, ventilators, medication, or surgery, such as a tracheostomy.
How long can you last with respiratory failure?
This depends on the type you have. Acute respiratory failure is life-threatening and requires a trip to the hospital right away. One study found that around 40% of people with acute respiratory distress lose their lives.
You can manage chronic respiratory failure with medication and oxygen therapy if needed. Researchers tracked people with chronic respiratory failure for over 4 ½ years to see what factors affected how long they lived. Nearly half lost their lives during the study. Researchers linked age, how well your lungs work, and other factors to survival.
Is tracheal stenosis acute hypoxic respiratory failure?
Hypoxic respiratory failure happens when you don't have enough oxygen in your blood, and inflammation or scarring on your windpipe (trachea) causes tracheal stenosis. The condition narrows your trachea, making it harder for you to breathe.
Can coronary artery disease cause respiratory failure?
Yes. Diseases that affect your heart are a risk factor for respiratory failure.
Acute Respiratory Failure: Causes, Symptoms, And Prevention - Medical News Today
In acute respiratory failure, the usual exchange between oxygen and carbon dioxide (CO2) in the lungs does not occur. As a result, the heart, brain, and other organs cannot get enough oxygen. A person may feel sleepy or faint.
Acute respiratory failure occurs when the air sacs of the lungs cannot release enough oxygen into the blood. This can be due to fluid buildup, hardening of the air sac walls, asthma-induced muscle spasms, and many other conditions that affect lung function.
In this article, we detail the types of acute respiratory failure, their causes, symptoms, and treatments.
Doctors typically classify acute respiratory failure as one of two types: hypoxemic or hypercapnic.
Hypoxemic respiratory failure
In this type of the condition, there is not enough oxygen in a person's blood. This is due to a failure in oxygen exchange in the lungs, which can result from swelling of the lungs or fluid buildup.
A person experiencing this will still have stable CO2 levels in their blood.
Hypercapnic respiratory failure
A person with hypercapnic respiratory failure will have higher levels of CO2 in their blood. Their blood oxygen levels may remain steady or be lower than usual.
Hypercapnic respiratory failure occurs when the lungs' alveoli, or air sacs, cannot adequately excrete CO2 that the body produces.
Acute vs. Chronic
Respiratory failure can be acute or chronic. Acute respiratory failure will occur suddenly and require immediate medical attention. This may be due to direct injury or rapid changes in lung function.
By contrast, chronic respiratory failure is an ongoing condition that develops over time and will typically require long-term treatment.
Generally, symptoms of acute respiratory failure depend on the underlying cause and may include changes in a person's appearance, ease of breathing, and behavior.
Acute respiratory failure usually stems from difficulty getting enough oxygen to the lungs, problems removing CO2 from the lungs, or both. This can be due to tissue damage, fluid buildup, muscular spasms, or other physical processes.
Determining the cause of acute respiratory failure helps a doctor determine the most appropriate treatments.
The above conditions and events can increase a person's risk of acute respiratory failure.
Moreover, babies born prematurely with underdeveloped lungs have a higher risk of acute respiratory failure due to pulmonary hypertension and neonatal respiratory distress.
Older adults may also be more likely to experience acute respiratory failure due to an increased susceptibility to infection and a weakening of the lung muscles.
Other risk factors for acute respiratory failure include:
To diagnose acute respiratory failure, a doctor will consider a person's symptoms and often order a range of tests.
By assessing the gas levels in a person's blood, a doctor will be able to determine whether acute respiratory failure is hypoxemic or hypercapnic.
Imaging tests will allow them to check for physical obstructions in the lungs, such as:
A doctor may order additional tests to rule out other potential causes of shortness of breath. These tests may include:
Acute respiratory failure can lead to a range of complications, some of which can be fatal. These include:
Treatments for acute respiratory failure depend on the underlying cause. However, most people with acute respiratory failure are likely to require extra oxygen as an initial course of treatment.
Doctors typically use this method of delivering oxygen until they can slow down the progression of, resolve, or reverse the underlying cause of respiratory failure.
In the short term, an individual may also require:
A doctor may also prescribe medications to sedate a person, making breathing with the ventilator easier to tolerate.
Not all causes of acute respiratory failure, such as trauma, are preventable.
However, in the case of pneumonia and some other airway-related conditions, a person can take some steps to protect their lungs.
If an individual has a history of lung problems and hospitalization, they should discuss with a doctor 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 condition from worsening.
Heart Disease Deaths Decline Over Last 50 Years, But Not Across The Board
The number of deaths attributable to heart disease, particularly acute myocardial infarction and ischemic heart disease, has declined significantly in the United States over the past 50 years or so, new research shows.
Despite the good news, there are worrisome developments, including the rise in deaths from other types of heart disease.
"Ischemic heart disease is still a huge problem and it's something that we continue to face, but we really saw about an 80% increase in mortality from things like heart failure; hypertensive heart disease, which really is a type of heart failure; and arrythmias," lead investigator Sara King, MD (Stanford University School of Medicine, CA), told TCTMD. "We also saw increases [in mortality from] from pulmonary hypertension or pulmonary heart disease and increases in mortality from valvular heart disease."
While the study was not designed to address why the causes of death have changed, King said the data likely reflect a shift toward more chronic heart disease in the US population.
"With our aging population, people are now surviving these acute ischemic events," she said. "They're living longer, so there's more time for them to have these disease processes and to die from them. I don't think we've made quite the progress with these other heart conditions as we have with myocardial infarction."
The new study, published Wednesday in the Journal of the American Heart Association, spans from 1970 to 2022 and includes data from the National Vital Statistics System available through the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) resource. During this time, the US population 25 years and older increased from 108.9 million to 229 million and life expectancy increased from 70.9 to 77.5 years.
Over the 52-year period, 31% of all deaths were attributable to heart disease. In 1970, heart disease accounted for 41% of total deaths, of which the vast majority (91%) were from ischemic heart disease. Among those who died from ischemic heart disease, 54% had an acute MI and 46% had chronic disease.
In 2022, just 24% of all deaths were due to heart disease. Here, 53% of deaths were attributable to ischemic heart disease and 47% from other forms of heart disease. Of the ischemic heart disease deaths in 2022, 29% were related to acute MI and 71% to chronic disease.
Cardiovascular disease remains the number one cause of death in the US, but age-adjusted mortality for all types of heart disease declined by 66% from 1970 to 2022. For acute MI, age-adjusted mortality decreased by 89%, dropping from 354 to 40 deaths per 100,000 people. Similarly, age-adjusted mortality from chronic ischemic heart disease declined by 71%, falling from 343 to 98 deaths per 100,000 people. Mortality from all types of ischemic heart disease declined by 81% from 693 to 135 deaths per 100,000 people.
Conversely, age-adjusted deaths for other types of heart disease—rheumatic heart disease, cardiomyopathy, heart failure, arrhythmias, valvular heart disease, hypertensive heart disease, pulmonary heart disease, and cardiac arrest/ventricular arrhythmias—increased 81% from 1970 to 2022 (68 to 123 deaths per 100,000). Deaths from heart failure, hypertensive heart disease, and arrhythmias increased the most during the study period, up 146%, 106%, and 450%, respectively. Only deaths from rheumatic heart disease declined over time (85% decrease).
With our aging population, people are now surviving these acute ischemic events. Sara King
The study period spans an era that includes multiple advances to reduce the risk of dying from ischemic heart disease, including the introduction of CABG surgery, cardiac imaging, balloon angioplasty, thrombolytic therapy, and aspirin, say investigators. There also was the establishment of PCI and an emphasis on rapid door-to-balloon times as well as the routine use of secondary prevention drugs such as beta-blockers, renin-angiotensin-aldosterone system inhibitors, and statins. High-sensitivity troponin testing led to more rapid diagnoses, and the use of more advanced antiplatelet agents after revascularization aided the decline in ischemic heart disease deaths, they say.
There have also been public health efforts to reduce cholesterol and blood pressure, among other interventions. "One big thing is the decline in tobacco use," said King. "I think that was a huge public health accomplishment." In 1970, roughly 40% of adults smoked, as compared with 14% in 2019.
There are different challenges today, with a rising prevalence of obesity, diabetes, and hypertension, as well as declining physical activity levels, say researchers. Still, King is optimistic that medical advances will continue to make similar inroads against these other cardiovascular diseases. "I think we've made really big leaps with heart failure and our four pillars of drug therapy," she said. "I am hopeful we'll just kind of keep making breakthroughs."
King acknowledged limitations to their analysis, noting that it relied on ICD coding for the cause of death and that there is the potential for misclassification. Also, deaths from heart failure, cardiomyopathy, and arrythmias (particularly ventricular arrhythmias) might also have ischemic causes that aren't captured with ICD coding, say the researchers.
"I think overall, though, the trends are quite clear," said King.
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