Acute hypoxic respiratory failure: symptoms, causes and treatment

acute hypoxic respiratory failure
Medically reviewed by Dr. Ola Tarabzuni

Key takeaways

  1. Hypoxia respiratory failure is a serious medical condition comprised of less oxygen supply to blood leading to improper functioning of the organs. It can be due to a number of underlying conditions. 
  2. Symptoms include shortness of breath, wheezing, cough, and chest tightness that can be felt. Causes include COPD, environmental allergens, cardiac issues, muscle weakness, pleural effusion, and pulmonary edema. 
  3. Treatment options vary depending on the underlying cause for which a timely diagnosis by a healthcare provider is a must. Medications like bronchodilators, diuretics, antibiotics, and antiviral medications are prescribed for the management of respiratory failure.


Acute hypoxic respiratory failure is one of the serious lung conditions affecting one’s breathing and respiratory system badly. It is basically the lack of oxygen supply from the lungs to body parts, impairing the functionalities of organs. The first signs and symptoms include shortness of breath, wheezing, cough, and chest tightness. Causes can be diverse, ranging from pulmonary edema to COPD and allergens.

Treatment options for hypoxic respiratory failure depend on the underlying cause. Medications, including bronchodilators, diuretics, antibiotics, and antiviral medications, are prescribed by healthcare providers to manage respiratory failure as well as the underlying condition affecting this. 

What is acute hypoxic respiratory failure?

Hypoxia respiratory failure is a serious medical condition characterized by less oxygen supply to blood and eventually to organs from the lungs leading to improper functioning. Lack of oxygen or excess carbon dioxide in your blood can cause hypoxia and respiratory failure in the body. 

The medical term “hypo” indicates less amount than the standard or required amount. Hypoxia can lead to improper functioning of the lungs, especially the respiratory system, which can lead to shortness of breath, dizziness, and blushing of the extremities. 

This condition is classified into two types on the basis of severity. 

  • Acute 
  • Chronic 

Acute hypoxic respiratory failure indicates less severity and effect on the body as compared to chronic failure, which is fatal. Either acute or chronic, they need immediate medical attention from the healthcare provider.

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What causes acute hypoxic respiratory failure?

Acute hypoxic respiratory failure can be caused due to diverse reasons. It basically happens when the blood vessels get narrowed, and their ability to exchange oxygen and carbon dioxide fails or is limited.

Following are all the other reasons that can affect hypoxic respiratory failure.

1. Lung conditions

Underlying lung conditions are one of the most common reasons to affect the lungs and respiratory system. Conditions such as Pneumonia (Inflammation of lung alveoli) and Acute Respiratory Distress Syndrome (ARDS) triggered by inflammation can affect and cause respiratory failure. 

2. Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disorder ( COPD) is also a serious lung condition characterized by inflammation of the airways of the lungs due to excess mucus, causing obstruction of airways and difficulty breathing. It can be life-threatening as it can cause fluid retention in the cavities of the lungs, leading to pleural effusion.

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3. Pulmonary embolism

It’s a condition in which the blood clot aggregates and travels to the lungs from the bloodstream. A blood clot blocks the vessel, leading to loss of oxygen and carbon dioxide exchange. Pulmonary embolism can also cause shortness of breath (SOB) or acute hypoxic respiratory failure.

4. Asthma

Asthma is a lung condition where the alveoli of the lungs get affected and are unable to function properly. The reasons for asthma could be genetics or allergy triggers. Severe asthma attacks and recurrent episodes of SOB can lead to acute hypoxia respiratory disorder and can present itself with symptoms like chronic shortness of breath, Chest tightness, wheezing, and sometimes cough.

5. Hypoventilation

Hypoventilation is also the lack of oxygenation in the body due to lung impairment. Conditions like muscle weakness, reduced respiratory drive due to drug overdose, and neurological disorders can result in inadequate ventilation and oxygenation.
Obesity is one of the leading causes of hypoventilation, causing obesity hypoventilation syndrome, affecting 35% of the country’s population in the United States.

6. Cardiovascular issues

Heart rate changes usually affect the person’s overall health, especially respiratory health. Heart failure often leads to pulmonary edema (fluid in the outer cavity) and impaired sense of breathing. It can be one of the reasons causing acute hypoxia and respiratory failure.

7. Other reasons

Other reasons can be inhalation injuries, high altitudes, sudden onset of allergies, or infections that affect different organs in the body, eventually affecting the respiratory system of the body.  It’s good to get a medical consultation on observing the first few symptoms of hypoxia to obtain the needed healthcare services at the right time.

What is one of the first signs of acute hypoxemic respiratory failure?

One of the first signs of acute hypoxemic respiratory failure is dyspnea, also called Shortness of breath(SOB), even on the slightest physical activity. A person will have difficulty breathing while lying down or changing position while in bed. 

Some other initial signs are as follows: 

  1. Tachypnea (Rapid, faster breathing than usual) 
  2. Restlessness and Anxiety
  3. Increased Heart Rate (Tachycardia)
  4. Cyanosis (Bluish skin, nails and lips)
  5. Altered Mental State
  6. Constant confusion 
  7. Fatigue, dizziness
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What does hypoxic respiratory failure feel like?

Hypoxic respiratory failure feels like someone is holding your throat so tight that you are unable to breathe. It can also feel like you are willing and trying to breathe, but there is not enough oxygen in the surroundings to inhale. 

It can also lead to dizziness, light-headedness, and confusion. Shortness of breath can be one of the most discomforting signs one can experience.

How is hypoxic respiratory failure diagnosed?

Hypoxic respiratory failure can only be diagnosed by the healthcare provider. Diagnosing will be comprised of the following:

1. Health and physical examination

Your healthcare provider will examine your heart rate, lung capacity, and breathing rhythm. It will indicate alot about your presenting condition. He might also ask about your existing lung condition or previous healthcare history related to the lungs or heart. 

2. Pulse oximetry and Blood gas analysis

These are the initial tests performed by healthcare providers to check your oxygen saturation level in the body and the bicarbonates and PH in the body. ABG results can confirm the severity of hypoxemia and guide treatment decisions to the healthcare provider as well.

3. Imaging and blood tests

Imaging tests, including CT scans and X-rays, can help diagnose respiratory failure correctly. Blood tests like CBC ( Complete Blood count) help in diagnosing any infection or underlying heart condition by the changes in blood cells in the body.

What medication is used for hypoxemic respiratory failure?

Treatment for acute hypoxic respiratory failure depends mainly upon the underlying cause. All the medications and lifestyle modifications will be suggested according to the severity of the condition after consultation with the healthcare provider. 

Following are the classes of medications that will be suggested by healthcare providers for hypoxia.

1. Bronchodilators

Bronchodilators will dilate the bronchioles (building blocks of lungs)  in the lungs. Either short-acting or long-acting bronchodilators will be suggested. Examples include albuterol and ipratropium.

2. Corticosteroids

Corticosteroids also help by dilating the blood and lung vessels. Methylprednisolone and dexamethasone are the most prescribed for acute hypoxia according to the condition and severity of the respiratory failure. 

3. Antibiotics

Depending on the confirmed bacterial infection, a wide range of antibiotics can be prescribed by healthcare providers. Majorly prescribed antibiotics for hypoxia respiratory failure are Ciprofloxacin, Amoxicillin-clavulanate, and Azithromycin. They all are prescribed in different dosages and dosage forms according to the condition of the patient.

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4. Antiviral medications

Antiviral medications are prescribed if the underlying cause of respiratory failure emerges from the viral infection. One of the antiviral medications prescribed is oseltamivir (Tamiflu) for influenza, which leads to respiratory failure.

5. Diuretics

The healthcare provider prescribes diuretics for the underlying condition like Pleural effusion or pulmonary edema leading to hypoxic respiratory failure. The most prescribed diuretic is furosemide.

6. Sedatives and analgesics

Sedatives and analgesics are also prescribed for pain relief. examples include midazolam for sedation and opioids (morphine)  for pain relief. NSAID medication is not used in case of respiratory failure. 

7. Other medications

Medications like Neuromuscular blockers (vecuronium and rocuronium) and Pulmonary Vasodilators(nitric oxide and epoprostenol) are prescribed for different underlying conditions, eventually leading to respiratory failure and shortness of breath.

What are the potential complications of acute respiratory failure?

Acute respiratory failure can come with a set of discomforting potential fatal complications. If the respiratory is left untreated, it can lead to conditions like Multi-Organ Failure other than the lung. Heart, liver, and kidney failure are expected, after which the treatment is quite impossible to regain the normal functions of the lungs and respiratory system. 

Long-Term Respiratory Impairment is only one of the major complications that can be caused if the initial treatment is not given and the treatment by a healthcare provider is neglected.

How can respiratory failure be prevented?

Most of the respiratory failures and fatal diseases of the lung are caused by smoking and nicotine intake by inhalation. Cessation of smoking can be the first step to avoid any lung-related disorder and abnormality. 

People suffering from conditions directly affected by environmental toxins should take care and avoid triggers. Healthcare providers prescribe antihistamine medications for allergy treatment, and they should be taken as per the directions.  

Good lifestyle modifications, avoiding high-risk activities, proper diagnosis by a healthcare provider, good hygiene, and smoking cessation are all preventive measures that can prevent hypoxic respiratory failure and any lung disease.

Consult a doctor

Consulting healthcare providers at the right time for any changes you feel in your breathing or heart rhythm can help you prevent bigger medical problems. Get medical consultation now with our virtual healthcare experts at the ease of your home.

FAQs about acute hypoxic respiratory failure

Is acute hypoxemic respiratory failure serious?

Yes, it is serious. If any of the related symptoms of acute hypoxemic respiratory failure are ignored and left untreated, they can lead to multi-organ failure or COPD, which are severe and need intensive care for treatment.

How long does hypoxic hypoxia last?

It depends on the condition and severity of the underlying condition. If it’s severe and undiagnosed, it will last until it’s diagnosed and treated by healthcare experts. It can last but improve when you are on medication.

Can you recover from acute hypoxemic respiratory failure?

Yes, a person can recover from acute hypoxemic respiratory failure if he gets the right diagnosis and treatment for the underlying and presenting condition. It might take from 8 days to a month for all the symptoms to go.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Bartlett, Robert H., et al. “A prospective study of acute hypoxic respiratory failure.” Chest 89.5 (1986): 684-689.
  • Prescott, Hallie C., et al. “Late mortality after acute hypoxic respiratory failure.” Thorax 73.7 (2018): 618-625.
  • Ferreyro, Bruno L., et al. “Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis.” Jama 324.1 (2020): 57-67.

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