Classification of Causes of Respiratory Failure

Written by Han Shun Li
Pulmonology
Updated on September 15, 2024
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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.

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Can respiratory failure be cured?

Whether respiratory failure can be cured depends on the causes of the respiratory failure and the severity of the condition. Respiratory failure can potentially be cured. For example, acute left heart failure can lead to pulmonary congestion and subsequent respiratory failure. This condition primarily manifests as a decrease in oxygen tension, and by conducting a blood gas analysis, if the oxygen tension is found to be less than 60 mmHg, it can be diagnosed as respiratory failure. However, with symptomatic treatments such as vasodilation and diuretics, once the left heart failure is alleviated, the respiratory failure will also improve. On the other hand, for diseases intrinsic to the lungs, such as chronic obstructive pulmonary disease or severe pulmonary infections, these chronic conditions cannot be completely cured. The symptoms of respiratory failure can only be managed with medication or ventilators.

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What are the symptoms of respiratory failure?

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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Is respiratory failure uncomfortable?

Respiratory failure is quite uncomfortable, and clinically, the symptoms feel severe, and the patient's own state is also very affected. Respiratory failure is mainly caused by a decrease in oxygen partial pressure, during which time the patient may experience wheezing, chest tightness, and even a feeling of being near death. There are many causes of respiratory failure, with severe infections being common, such as severe pneumonia or sepsis. A systemic inflammatory response can lead to respiratory failure. Another situation is when heart failure occurs, which can also accompany pulmonary congestion, causing pulmonary ventilation dysfunction that can also lead to respiratory failure. The treatment of respiratory failure focuses on removing the causative factors and selectively choosing different treatment plans, which can start with oxygen therapy or the use of a ventilator in severe cases to correct hypoxemia and sustain life.

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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.