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What is Respiratory Failure?

Respiratory failure occurs when the exchange of gases within the lungs ceases to function effectively. This can occur gradually over a period of days or weeks, or rapidly over the space of minutes depending on the underlying cause. Episodes of rapid decline are classified as acute respiratory failure and are generally life threatening with a need for urgent intervention. Slow progressive decline or chronic respiratory failure can initially be hard to detect as symptoms will be common to many types of respiratory condition.

Improving lung function and exercise tolerance with supervision from a physiotherapistAbove: Improving lung function and exercise tolerance with supervision from a physiotherapist

What causes Respiratory Failure?

The failure of effective gas exchange in the lungs can result from disruption or damage to any one of the basic structures involved. These include the central nervous system, respiratory muscles, Bronchial airways and alveoli where gas exchange takes place. Although there is multiple underlying medical conditions that can lead to respiratory failure, they broadly fall into two main types.

Type 1 or Hypoxemic Respiratory Failure concerns the proportionally low concentration of oxygen (O2) present in the arterial blood. Carbon dioxide (CO2) levels would remain normal, or slightly decreased. This can occur from a lung ventilation and blood perfusion mismatch (V/Q mismatch). Where either the available lung space for gas transfer is reduced due to disease, or blood flow around parts of the lung tissue is decreased due to injury or illness. Alternatively a small percentage of deoxygenated blood can bypass (Shunt) the alveoli of the lungs and re-join with the remaining oxygenated blood, together bringing the overall oxygen saturation down. This can result from bleeds in either parts of the lung or heart and does not significantly respond to enriched oxygen delivered via a mask.

Type 2 or Hypercapnic Respiratory Failure concerns the proportionally high retention of carbon dioxide (CO2) within the blood. The body produces a consistent amount of CO2 which is expelled through the lungs. If there is a reduction in available lung ventilation, or a decrease in respiratory rate and shallow breathing, then CO2 levels can quickly increase. Fortunately this type of respiratory failure responds positively and quickly to oxygen therapy.

What are the symptoms of Respiratory Failure?

Respiratory Failure has a number of distinct symptoms, however some can be subtle and initially hard to detect if they progress slowly. A doctor or clinician will automatically have a greater suspicion of any presenting symptoms if they are aware of any underlying conditions that may affect your breathing. The use of a digital blood oxygen meter can give a quick report of blood oxygen and carbon dioxide levels, greatly aiding the assessment of a person’s symptoms.

  • Difficulty breathing, leading to shortness of breath.
  • Restlessness.
  • Increased blueness to colouring of the skin, particularly lips and fingernail beds.
  • Decreased or irregular heartbeat.
  • Anxiety.
  • Confusion or difficulty concentrating.
  • Excessive tiredness.
  • Seizures can result from extreme lack of oxygen.
  • Coma may occur at the end stage of respiratory failure.

There may be many other symptoms present during an episode of respiratory failure, but they will usually be specific to a particular condition and may not be present for every case.

How is Respiratory Failure Diagnosed?

Respiratory Failure will be diagnosed by your doctor based on a combination of your immediate presentation of symptoms and your past medical history, particularly if you have an ongoing respiratory condition. If you suspect your ease of breathing is declining over a period of weeks you should arrange an emergency appointment with your GP. If you experience any rapid changes in your ease of breathing that fall outside normal expectations, i.e. shortness of breath from running, then you should contact emergency medical assistance immediately.

For more information on how physiotherapy can help manage the recovery from respiratory failure, or to book yourself a respiratory assessment, please contact us via email at or ring us on 0330 088 7800.

What would a physiotherapy assessment for Respiratory Failure?

At, we want to gain as much information as possible about your condition to ensure we give you the best treatment. In your first appointment with us, our physiotherapists will carry out an assessment which has two parts:


A discussion between you and our physiotherapist to find out what symptoms you are experiencing, and how your condition is affecting you and your lifestyle.


An assessment to discern the presence of any pain, your current breathing pattern, respiration rate, lung volume and a series of special tests to identify the presence of any mucus retention and lung function impairment.

There can be great variation in the symptoms displayed, depending on the progression of the condition and any complicating factors. The assessment process will be important in identifying your current symptoms and needs, so that treatments can be targeted and effective.

What would physiotherapy treatment for Respiratory Failure involve?

The principle goal in treating Respiratory Failure is addressing the lack of oxygen reaching the bodies tissues, then clearing any retained carbon dioxide. Lack of oxygen can quickly lead to tissue damage whereas retained CO2 can be tolerated for longer periods, until it begins to make the blood more acidic. The correction of blood gasses in respiratory failure is most commonly achieved by supplying enriched O2 via a nasal cannula or mask. In most cases this will rapidly correct any blood gas deficiency, or at least prop up the system until normal levels can stabilise. Hospital admission to a specialist respiratory ward would be expected for any new cases of respiratory failure, but oxygen therapy is so effective that many people with chronic failure self-administer O2 at home for the duration of their condition.

For people with acute respiratory failure of severe chronic failure the use of mechanical ventilation can support not only the exchange of gasses but the physical act of breathing. Modern ventilators use positive pressure when the individual breaths in to help stent the airway, allowing better circulation of air. This assistance is usually passively controlled, kicking in to support only once the person begins initiates an inward breath. For people with extreme respiratory muscle fatigue the entire work of breathing can be automated if necessary.

Your physiotherapist on the hospital ward will coach you in the use of oxygen therapy or machine ventilation if appropriate. Along with advice and therapy exercises specific to your condition. Which could include clearing chest secretions, reduced effort breathing techniques and activity modification. Once discharged we can continue your respiratory care employing some of the following treatments;

  • Secretion clearance:
    • Effective / productive coughing techniques.
    • Postural drainage in sitting and lying.
    • Manual assistance, including percussion, vibrations and shaking.
  • Breathing technique retraining:
    • Controlling respiratory rate
    • Diaphragmatic breathing
    • Controlling / reducing breath volume
    • Relaxation breathing exercises
  • Education and Advice:
    • Illness cause and progression.
    • Effects of environmental and allergen factors.
    • Medication management
    • Recognising signs of possible Asthmatic episodes

How can I arrange a physiotherapy assessment for Respiratory Failure?

If you have been diagnosed by your doctor as having suffered from respiratory failure and have symptoms affecting your breathing and lung clearance, you would benefit from an assessment with one of our experienced respiratory physiotherapists.

You can contact us directly to arrange an assessment and we can advise you if further treatment is recommended, and give you advice on self-management. To arrange an appointment please email or call 0330 088 7800.


At, our respiratory physiotherapists can provide specialist assessment and treatment for people whom have experienced respiratory failure. We can apply a range of therapy techniques and advice to manage your symptoms and maintain the best possible level of lung function and comfort. We can also advise on activity modification to make daily living easier. Along with advice for you and your family on appropriate self-management techniques to maximise your functional ability between therapy sessions.

For more information on how physiotherapy can help manage the recovery from respiratory failure, or to book yourself a respiratory assessment, please contact us via email at or ring us on 0330 088 7800.

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