Acute respiratory failure is a condition that is a medical emergency. It can develop quickly, and it should be treated right away. There are two types of acute respiratory failure:

• Type I respiratory failure is when the lungs are not able to get enough oxygen into the blood. This causes the blood oxygen level to drop.

• Type II respiratory failure is when carbon dioxide is not passing from the lungs out of the body. This causes carbon dioxide to build up in the blood.

Common causes of type I respiratory failure include:

• Trauma to the lung, chest, ribs, or tissues around the lung.

• Bronchiolitis.

• Pneumonia.

• Smoke, chemical, or water inhalation.

• Blood infection (sepsis).

Common causes of type II respiratory failure include:

• A blocked upper airway (choking).

• Spinal cord injury.

• Drug or alcohol overdose.

• Blood infection (sepsis).

• Stroke.

This condition is more likely to develop in children who have:

• A history of preterm birth.

• Lung diseases such as bronchopulmonary dysplasia (BPD), asthma, or cystic fibrosis (CF).

• A condition that damages or weakens the muscles, nerves, bones, or tissues that are involved in breathing, such as myasthenia gravis or Guillain–Barré syndrome.

• A serious infection.

• A health problem that blocks the unconscious reflex that is involved in breathing, such as hypothyroidism or sleep apnea.

Trouble breathing is the main symptom of acute respiratory failure. Symptoms may also include:

• Fast breathing, making whistling sounds when breathing (wheezing), or grunting.

• Flaring of the nostrils.

• Fast heart rate.

• Changes in behavior such as:

  • Confusion.

  • Fussiness.

  • Restlessness.

  • Anxiety.

• Sleeping more than normal or being hard to wake.

• Being unable to play or do normal activity.

• Skin, lips, or fingernails that appear blue (cyanosis).

This condition may be diagnosed based on:

• Your child’s medical history and a physical exam. Your child’s health care provider will listen to your child’s heart and lungs to check for abnormal sounds.

• Tests to confirm the diagnosis and determine the cause of respiratory failure. These tests may include:

  • Measuring the amount of oxygen in your child’s blood (pulse oximetry). The measurement comes from a small device that is placed on your child’s finger or toe.

  • Blood tests to measure oxygen and carbon dioxide and to look for signs of infection.

  • Tests on a sample of the fluid that surrounds the spinal cord (cerebrospinal fluid) or a sample of fluid that is drawn from the windpipe (trachea) to check for infections.

  • Chest X-ray.

  • Electrocardiogram (ECG) to look at the heart’s electrical activity.

Treatment for this condition usually takes place in a hospital intensive care unit (ICU). Treatment depends on what is causing the condition. It may include one or more of these treatments:

• Oxygen may be given through your child’s nose, a face mask, or a hood.

• A device such as a continuous positive airway pressure (CPAP) machine or bi-level positive airway pressure (BIPAP) machine may be used to help your child breathe. The device gives your child oxygen and pressure.

• Breathing treatments, fluids, and other medicines may be given.

• A ventilator may be used to help your child breathe. The machine gives your child oxygen and pressure. A tube is put into your child’s mouth and trachea to connect the ventilator. This device offers more control over your child’s breathing.

• In extreme cases, extracorporeal life support (ECLS) may be used. This treatment temporarily takes over the function of the heart and lungs, supplying oxygen and removing carbon dioxide. ECLS gives the lungs a chance to recover.

Medicines

• Give your child over-the-counter and prescription medicines only as told by the health care provider.

• If your child was prescribed an antibiotic medicine, give it to him or her as told by the health care provider. Do not stop giving the antibiotic even if he or she starts to feel better.

• Do not give your child aspirin because of the association with Reye’s syndrome.

• If your child is taking blood thinners:

  • Talk with your child’s health care provider before you give your child any medicines that contain aspirin or NSAIDs, such as ibuprofen. These medicines increase the risk for dangerous bleeding.

  • Make sure your child takes the medicine exactly as told, at the same time every day.

  • Have your child avoid activities that could cause injury or bruising, and follow instructions about how to prevent falls.

  • Have your child wear a medical alert bracelet or carry a card that lists what medicines he or she takes.

General instructions

• Have your child return to normal activities as told by your child’s health care provider. Ask the health care provider what activities are safe for your child.

• Your child should not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If he or she needs help quitting, ask your child’s health care provider.

• Do not smoke around your child. Keep your child away from secondhand smoke. If you need help quitting, ask your health care provider.

• Keep all follow-up visits as told by your child’s health care provider. This is important.