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Acute respiratory failure

Last reviewed: 9 Aug 2025
Last updated: 23 Nov 2023

Summary

Definition

History and exam

Key diagnostic factors

  • direct trauma to the thorax and neck
  • dyspnea
  • confusion
  • tachypnea
  • accessory breathing muscle use
  • stridor
  • inability to speak
  • retraction of intercostal spaces
  • cyanosis
  • loss of airway/gag reflex
Full details

Other diagnostic factors

  • anxiety
  • headache
  • hypoventilation
  • cardiac rhythm disturbances
  • underlying neuromuscular disorder
  • drug use
  • seizure
  • coma
  • asterixis
  • papilledema
Full details

Risk factors

  • cigarette smoking
  • young age
  • older age
  • pulmonary infection
  • chronic lung disease
  • upper airway obstruction
  • lower airway obstruction
  • alveolar abnormalities
  • perfusion abnormalities
  • cardiac failure
  • peripheral nerve abnormalities
  • muscle system abnormalities
  • opioid and sedative medications
  • toxic fumes and gases
  • traumatic spinal injury
  • traumatic thoracic injury
  • central nervous system (CNS) disorders
  • acute vascular occlusion
  • pulmonary effusion
  • pneumothorax
  • hypercoagulable states
Full details

Diagnostic tests

1st tests to order

  • pulse oximetry
  • arterial blood gases
Full details

Tests to consider

  • CBC
  • D-dimer
  • serum bicarbonate (HCO₃)
  • Cardiac troponin I and/or T
  • ECG
  • chest x-ray
  • pulmonary function tests
  • Urine or serum toxicology
  • chest CT
  • CT pulmonary angiography (CTPA)
  • ventilation/perfusion lung scan
  • capnometry
  • cardiothoracic ultrasound
Full details

Emerging tests

  • transcutaneous CO₂ monitoring

Treatment algorithm

ACUTE

airway obstruction

no acute upper airway obstruction: stable

no acute upper airway obstruction: unstable

Contributors

Authors

Samuel J. Stratton, MD, MPH
Samuel J. Stratton

Professor

Fielding School of Public Health

David Geffen School of Medicine at UCLA

Los Angeles

Deputy Health Officer

Orange County Health Care Agency

Health Disaster Management/Emergency Medical Services

Santa Ana

CA

Disclosures

SJS declares that he has no competing interests.

Peer reviewers

C. Michael Roberts, MA, MD, FRCP

Consultant Physician

Barts Health

London

UK

Declarações

CMR declares that he has no competing interests.

Ken Miller, MD, PhD

University of California

Irvine and Orange County Fire Authority

Irvine

CA

Declarações

KM declares that he has no competing interests.

Christopher Kahn, MD, MPH

Assistant Professor of Clinical Emergency Medicine

Department of Emergency Medicine

University of California

Irvine and Orange County Fire Authority

Irvine

CA

Declarações

CK declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017 Aug 31;50(2):1602426.Texto completo  Resumo

Davidson C, Banham S, Elliott, et al. British Thoracic Society/Intensive Care Society guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. BMJ Open Respir Res. 2016 Mar 14;3(1):e000133.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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