Respiratory Failure in Adults: A Multidisciplinary Approach For Emergency, Prehospital, Nursing, And Healthcare Professionals-An Updated Review

Abstract

Background: Respiratory failure is a life-threatening clinical syndrome characterized by the inability of the respiratory system to maintain adequate oxygenation, ventilation, or both. It represents the final common pathway of numerous pulmonary and extrapulmonary disorders and is a major cause of emergency department visits, intensive care unit admissions, and mechanical ventilation. Prompt recognition and appropriate management are essential to reduce morbidity and mortality. Aim: This article aimed to provide a comprehensive, evidence-based review of adult respiratory failure, emphasizing its etiology, epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, management strategies, prognosis, and complications. Methods: A narrative literature review was conducted using current evidence from peer-reviewed publications and established clinical guidelines. The review synthesizes contemporary knowledge regarding the classification of respiratory failure into hypoxemic (Type 1) and hypercapnic (Type 2) forms, diagnostic approaches including arterial blood gas analysis and imaging modalities, and current principles of supportive and definitive management. Results: Respiratory failure results from diverse mechanisms affecting gas exchange, including ventilation-perfusion mismatch, diffusion impairment, right-to-left shunting, alveolar hypoventilation, and respiratory pump dysfunction. Early diagnosis relies on comprehensive clinical assessment supported by arterial blood gas analysis, pulse oximetry, imaging studies, capnography, and bedside lung ultrasonography. Management focuses on airway stabilization, optimization of oxygenation and ventilation, treatment of the underlying cause, and timely implementation of noninvasive or invasive mechanical ventilation when indicated. Prognosis varies according to the underlying disease, severity of respiratory dysfunction, and speed of therapeutic intervention, while delayed recognition increases the risk of multiorgan dysfunction and mortality. Conclusion: Respiratory failure remains a medical emergency requiring rapid assessment, accurate diagnosis, and multidisciplinary management. A thorough understanding of its pathophysiology and evidence-based therapeutic strategies is fundamental for improving patient outcomes and reducing complications across emergency, critical care, and general clinical practice.