The Difference Between Respiratory Distress, Failure, and Arrest

During each inhale and exhale, your lungs help your body to oxygenate your blood and blow off carbon dioxide. When this cycle becomes altered, it can have profound and potentially life-threatening effects on the body. 

Respiratory distress, failure, and arrest are often times confused with each other. While they are all terms that describe breathing difficulties, they are distinct from one another. 

Understanding the differences between these respiratory conditions is important for healthcare providers and the general public. Below is a closer look at each respiratory condition, how they differ from one another, and possible underlying conditions that can cause them. 

What Is Respiratory Distress?

Respiratory distress describes abnormal breathing that can become problematic if not addressed. 

Some of the common indicators of normal breathing include: 

  • Low respiratory effort (how hard you work for each breath)
  • Normal depth (tidal volume)
  • A rate of 12 to 20 breaths per minute
  • A pulse oximeter (blood oxygen) reading of 95 percent or higher

Changes outside of these norms when you are at rest can constitute respiratory distress.

What Are the Symptoms of Respiratory Distress?

Common signs and symptoms of respiratory distress can include:

  • Hyperventilating (taking too many breaths per minute) 
  • Hypoventilating (not taking enough breaths per minute)
  • Racing heart rate
  • Wheezing
  • Shortness of breath
  • Using your stomach, side, neck, or back muscles to breathe
  • Nasal flaring when breathing
  • In severe cases, a blue tint to the skin

Typically, individuals with respiratory distress are only able to speak in short phrases. Another sign of respiratory distress is tripod posturing, which is when someone places their hands on a surface or their knees and leans forward to try to get a bigger breath.

Respiratory distress needs to be assessed by a medical professional, as it could be an indication of a larger problem or a potentially life-threatening circumstance. Depending on the severity, interventions like supplemental oxygen, suctioning, or positive pressure ventilation may be used. 

What Causes Respiratory Distress?

Some common causes of acute respiratory distress syndrome (ARDS) include: 

  • Asthma
  • Bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Pneumonia
  • Pulmonary edema
  • Pleural effusion
  • Aspiration
  • Upper airway obstruction
  • Cardiogenic shock
  • Hemorrhagic shock
  • Neurogenic shock
  • Sepsis
  • Pulmonary embolism

This only scratches the surface of potential causes of respiratory distress, which is why any symptoms should be checked out by a medical professional. Your doctor can work with you to determine what may be the cause of your individual case.

What Is Respiratory Failure?

Respiratory failure happens when the lungs and respiratory system are unable to meet the demands of the body. 

Respiratory failure can be broken down into two main groups: acute respiratory failure and chronic respiratory failure. Both types require medical intervention to avoid critically low oxygen levels and further respiratory decline.

What Are the Signs of Respiratory Failure?

Some common signs that someone is in respiratory failure are related to the fact that the individual is not getting enough oxygen to their tissues. Others are related to a buildup of carbon dioxide. 

Some signs and symptoms of respiratory failure include:

  • Inability to perform daily tasks
  • Fatigue
  • A pale or blue tinge to the extremities 
  • Abnormal breathing rate
  • Higher than normal respiratory effort
  • Using your stomach, side, neck, or back muscles to breathe
  • Low blood oxygen levels

What Causes Respiratory Failure?

Acute (or sudden) respiratory failure can occur as a result of unmanaged respiratory distress, physical injury to the lungs, fluid in the lungs, some viral diseases, and altered regulation of the diaphragm. 

Chronic (or long-term) respiratory failure tends to be caused by lung diseases like chronic obstructive pulmonary disease (COPD) and emphysema, which slowly accrue over time and reduce the ability of the lungs. 

What Is Respiratory Arrest?

Respiratory arrest is the most critical type of breathing condition and describes when a person is unable to breathe on their own. This is also called apnea. When a person is apneic, their diaphragm is unable to expand the lungs and provide mechanical ventilation of air in and out of the lungs. 

Respiratory arrest is a medical emergency and requires positive pressure ventilation of high-flow oxygen. 

When a person stops breathing, the body is unable to absorb oxygen from the air during inhalation or offload carbon dioxide during exhalation. Manually forcing air into the lungs via a bag valve mask, supraglottic airway device, or intubation is the only way to save someone in respiratory arrest. 

What Are the Warning Signs of Respiratory Arrest?

The largest warning sign of impending respiratory arrest is decompensation, which is when your body stops being able to keep up with the physical demands of breathing. 

When the body is in need of oxygen, the brain stem will send signals to the diaphragm to increase breathing depth and rate to try and keep oxygen and carbon dioxide levels adequate within the body. Increasing the depth, rate, and effort of the lungs is a short-term fix to help normalize blood gases in the body. 

If the lungs are constantly working with this much effort, they may begin to become worn out, resulting in decompensation. 

Warning signs of decompensation include: 

  • Slowed rate of breathing
  • Irregular breaths
  • Slow heart rate 
  • Loss of consciousness
  • A blue tinge around the lips

What Causes Respiratory Arrest?

Respiratory arrest can occur for a number of reasons. These can include: 

  • Drug overdose
  • Cardiac arrest
  • Cervical spine injury
  • Complete upper airway obstruction
  • Mismanaged respiratory distress and failure

Respiratory distress and failure require immediate treatment to prevent them from escalating into complete respiratory arrest. An individual that falls into respiratory arrest may be intubated and placed on a ventilator, which carries its own set of risks and complications. 

How Can You Tell the Difference Between Respiratory Distress, Failure, and Arrest?

When you look at a person, it is easy enough to determine whether they are in respiratory arrest or not based on whether they are able to breathe on their own. 

If an individual is breathing, it can become slightly harder to differentiate between respiratory distress and failure based on just looks alone. The differences, however, are more about semantics than anything else.

A person in respiratory failure can also be in respiratory distress, while a person in respiratory distress could quickly enter into respiratory failure if they don’t receive timely treatment.

The main difference has to do with the fact that distress generally describes abnormal breathing, while failure describes the eventual effects of abnormal breathing on the body.

How Are Respiratory Distress, Failure, and Arrest Diagnosed?

Diagnosis of these conditions is typically made through a physical examination, patient presentation, and medical history. Further tests like chest X-rays, pulmonary function tests, and blood oxygen saturation using arterial blood may be used to better understand the underlying cause. 

Respiratory distress is diagnosed by assessing an individual's breathing, which includes how well they are moving air in and out of their lungs, the rate at which they are breathing, and how effective the breathing is in properly oxygenating the blood. If any of these indicators are out of the normal range for a person at rest, a diagnosis may be made for respiratory distress. 

Respiratory failure is diagnosed by not only assessing breathing but also comparing the effectiveness of your breathing to how much oxygen your body needs. If your lungs are simply not able to keep up with the demands of your body, then you may be diagnosed with respiratory failure. 

This can feel daunting, but there are things you can do that may help with early-stage respiratory failure, such as enrolling in a pulmonary rehab such as Carda Health

Pulmonary rehab is a multidisciplinary program that aims to improve your standard of cardiovascular health through monitored exercise and education on topics such as pulmonary failure, nutrition, and mental health. The program will not cure respiratory failure, but it could help you to build cardiovascular endurance to have a higher quality of life. 

Respiratory arrest is diagnosed by an absence of breath. Many times, respiratory arrest is also compounded with cardiac arrest, and timely cardiopulmonary resuscitation (CPR) is required. CPR includes chest compressions, positive pressure ventilation, and the use of an automated external defibrillator (AED) to try and restore a productive heart rhythm and breathing. 

The Bottom Line

Respiratory distress, failure, and arrest are three conditions related to breathing difficulties that require prompt and proper treatment. Understanding the difference between these conditions is crucial for proper diagnosis and treatment, especially in life-threatening situations. 

Healthcare providers may use mechanical ventilation, positive pressure ventilation, or suctioning to treat these conditions and prevent further complications such as low blood oxygen levels, high levels of carbon dioxide, and low breathing rates. In some severe cases, intubation or other forms of life support may be necessary.

If you have any preexisting lung conditions or a predisposition to respiratory failure, consider enrolling in a cardiopulmonary rehab program like Carda Health. Enrolling early can be a great preventative measure that can help improve your overall health and reduce the chances of developing full-on respiratory failure. 


Blood Oxygen Level: What It Is & How To Increase It | Cleveland Clinic

Respiratory Failure - Causes and Risk Factors | NHLBI, NIH

Overview of Respiratory Arrest | Merk Manuals

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