Lung and respiratory failure

The lungs are a spongy, pinkish organ that form the centre of the respiratory (breathing) system. Every cell of the body needs oxygen to stay alive and healthy. These cells release carbon dioxide as a waste product that needs to be expelled from the body. The lungs perform this exchange of gases every time you breathe in and out.

The respiratory system is made up of a right lung, left lung, trachea, bronchi, bronchioles and alveoli. The right lung is made up of three lobes, while the left lung has only two lobes to make room for the heart. The lungs begin at the bottom of the trachea, otherwise called the windpipe. The trachea carries the air in and out of the lungs.

The tube-like trachea branches off into two smaller tubes called bronchi that connect to the right and left lung. Within the lungs, each bronchus branches off into smaller tubes called bronchioles. There are almost 30,000 bronchioles in each lung. Each bronchiole ends in a cluster of small air sacs called alveoli. There are about 600 million alveoli in your lungs.

It is the alveoli that give the lungs a vast amount of surface area to perform the vital exchange of gases.

Respiratory failure

Respiratory failure occurs when the respiratory system is unable to perform its primary function. Respiratory failure may be acute or chronic. Acute respiratory failure is a short-term condition. It occurs suddenly and is typically treated as a medical emergency. Chronic respiratory failure is an ongoing condition. It gradually develops over time and requires long-term treatment.

The two types of respiratory failure are hypoxemic and hypercapnic. Hypoxemic respiratory failure means that there isn’t enough oxygen in the blood, but the level of carbon dioxide is close to normal. Hypercapnic respiratory failure means that there is too much carbon dioxide in the blood and insufficient oxygen as well.

People with acute failure of the lungs may experience:

  • Restlessness
  • Anxiety
  • Sleepiness
  • loss of consciousness
  • rapid and shallow breathing
  • racing heart
  • irregular heartbeats (arrhythmias)
  • profuse sweating

People with chronic respiratory failure may experience:

  • difficulty breathing or shortness of breath, especially when active
  • coughing up mucus
  • wheezing
  • bluish colouration of the skin, lips or fingernails
  • rapid breathing
  • fatigue
  • anxiety
  • confusion
  • daily headache

Acute respiratory failure has several different causes:

  • Obstruction: Obstruction can occur in people with chronic obstructive pulmonary disease (COPD) or asthma when an exacerbation causes the airways to become narrow.
  • Injury: An injury that impairs or compromises the respiratory system can adversely affect the amount of oxygen in the blood. An injury to the ribs or chest can also hamper the breathing process. These injuries can impair one’s ability to inhale enough oxygen into the lungs.
  • Drug or alcohol abuse: If you overdose on drugs or drink too much alcohol, it can impair brain function and hinder the ability to breathe in or exhale.
  • Chemical inhalation: Inhaling toxic chemicals, smoke or fumes can injure or damage the tissues of the lungs, including the air sacs.
  • Stroke: A stroke often affects one side of the body. If you have a stroke, you may lose the ability to breathe properly. Infection: Infections are a common cause of respiratory distress. Pneumonia in particular, may cause respiratory failure.

Chronic respiratory failure has several different causes:

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Complicated pneumonia
  • Cystic fibrosis
  • Spinal cord injuries
  • Stroke
  • Muscular dystrophy
  • ALS (Lou Gehrig’s disease)
  • Injury to the chest
  • Drug or alcohol misuse
  • Smoking

If you can breathe adequately on your own and your hypoxemia is mild, you may receive oxygen from an oxygen tank to help you breathe better. If you can’t breathe adequately on your own, your doctor may insert a breathing tube into your mouth or nose and connect the tube to a ventilator to help you breathe.

If you require prolonged ventilator support, a procedure called tracheostomy may be necessary to create an artificial airway in the windpipe. You may receive oxygen via an oxygen tank or ventilator to help you breathe better.

Treatment options for chronic respiratory failure include:

  • Oxygen therapy
  • Non-invasive ventilation (BiPAP and CPAP)
  • Mechanical ventilation
  • Lung transplant

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