Chronic Respiratory Failure

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is a life-threatening condition in which respiratory function is inadequate to maintain the body's need for oxygen supply and carbon dioxide removal while at rest. It usually occurs when a patient with chronic airflow limitation develops an infection or otherwise suffers an additional strain on already seriously impaired respiratory functions. Inadequate or unsuccessful treatment of respiratory insufficiency from a variety of causes can lead to respiratory failure. Also called ventilatory failure.

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Signs & Symptoms

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• difficulty breathing or shortness of breath, especially when active.

• coughing up mucous.

• wheezing.

• bluish tint to the skin, lips, or fingernails.

• rapid breathing.

• fatigue.

• anxiety.

• confusion.

Treatment of Respiratory Failure

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This may include:

• Oxygen - high levels will be given through a mask (although lower levels may be needed in patients with chronic respiratory failure who have adapted to high carbon dioxide levels).

• Artificial ventilation:

  • Mechanical ventilation:

    • This involves the patient being put into a coma, using medication and paralysing their breathing.

    • A tube is inserted into the trachea and an artificial ventilator then does the work of breathing.

    • Once the underlying cause is treated, patients will be 'weaned' off the ventilator so that their lungs start to do the work of breathing.

    • This is a form of 'invasive' ventilation.

  • Non-invasive ventilation (NIV):   (Best option in home setting)

    • This is an alternative to invasive ventilation and is increasingly being used, especially in cases where weaning from an artificial ventilator may prove difficult.

    • It is used when there is a low blood oxygen level and high blood carbon dioxide level, ie type II respiratory failure. The main disease it is used in is chronic obstructive pulmonary disease (COPD).

    • It can also be used to help wean patients from invasive ventilation.

  • Extracorporeal membrane oxygenation (ECMO):

    • This is a more recent technique being used in patients of all ages.

    • It involves blood being artificially removed from the body and then oxygen being added by a machine whilst carbon dioxide is removed. The blood is then returned to the patient.

    • One of the main uses of this method in adults at present is in severe heart failure where other treatments have failed.

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• The underlying cause may also require treatment - for example, steroids and antibiotics.

• For some patients there may not be any further treatment options and their respiratory failure may be terminal. They may benefit from the palliative care team, which deals with managing patients with terminal illnesses.