Types of Respiratory Failure

Sam Nunn – 19 November 2023

I’ve been setting up an awful lot of non-invasive ventilation lately. While engaging in a bit of ventilator voodoo, I noticed a neat little way to think about the types1 of respiratory failure and their treatment. Let me explain…

Type One

In type one respiratory failure, oxygenation is impaired. The main problem, by hook or by crook, is that not enough oxygen (one gas) is making its way from the atmosphere to the mitochondria. Patients who are failing to oxygenate typically benefit from a bit of CPAP (one pressure level) to push a little more oxygen into their bloodstream (and potentially splint open a few gummy alveoli).

Type Two

In type two respiratory failure patients are typically hypoxaemic and hypercapneic (two gasses broken) because they are not moving enough air to and from their alveoli. To boost their natural respiratory effort, we can apply a bit of BIPAP (two-level positive airway pressure) which does a terrific job of shifting that extra CO2.

All Together Now

Type of Respiratory FailureNumber of Wonky GassesNumber of Pressure Levels Used
OneOne (↓PaO2)One (CPAP)
TwoTwo (↓PaO2 and ꜛPaCO2)2Two (BiPAP/NIV)

One, one, one. Two, two, two. Not bad eh?

  1. We talk about “types” of respiratory failure to simplify the day-to-day task of describing what’s wrong with a patient’s breathing. Also to sound smart. 

  2. Usually. Don’t ruin my fun.