Treatment of breathing (respiratory) failure in intensive care

A plain-English guide for patients and families explaining how intensive care supports the lungs when breathing fails — from oxygen and masks to a ventilator — and what recovery may look like.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

Respiratory failure means the lungs cannot get enough oxygen in or clear enough carbon dioxide, and intensive care supports breathing while the cause is treated.
Support is given in steps — oxygen, a tight mask (CPAP or non-invasive ventilation), then a ventilator with sedation if needed.
Breathing support rests the lungs and buys time; it does not cure the underlying problem by itself, and recovery can be slow.
Coming off the ventilator is a gradual process called weaning; needing more support again at times is common and not a failure.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeIntensive care treatment supporting or taking over breathing

AnaestheticSedation, and often a general anaesthetic, are needed while on a ventilator

How long it takesSupport continues day and night for as long as the lungs need it

Hospital stayInpatient, often on an intensive care or critical care unit

Time off workRecovery is often slow, sometimes over many months

When you'll see resultsWhether the lungs recover usually becomes clearer over days to weeks

On the NHS?Provided by the NHS, usually as emergency or urgent care; not a private booking

A general guide. Your specialist will give you advice for your situation.

Best fit

Keeps enough oxygen reaching the body when the lungs are failing

Pause if

Full invasive ventilation may not be in someone's best interests if the underlying illness cannot be overcome; the team will discuss this.

Main recovery point

The team adjusts oxygen and ventilator settings as the lungs change. Progress is often measured in small steps, such as needing a little less oxygen each...

Good aftercare

A named contact on the unit and honest, regular updates for the family.

While on support

The team adjusts oxygen and ventilator settings as the lungs change. Progress is often measured in small steps...

Weaning off the ventilator

Sedation is lightened and the machine does less of the work, so the person breathes more for themselves. The tube...

After the tube comes out

A sore throat and weak voice are common. The person may still need oxygen or a mask at times, and is encouraged to...

First weeks

Breathlessness on effort, tiredness and weak muscles are normal. Physiotherapy and gradual activity help rebuild...

Medical line illustration of cpap sleep apnoea therapy for Treatment of breathing (respiratory) failure in intensive care. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What does treating respiratory failure in intensive care involve?

The lungs take oxygen into the body and clear out carbon dioxide. Respiratory failure means the lungs can no longer do this well enough — there is too little oxygen, too much carbon dioxide, or both. It can come on suddenly from problems such as severe pneumonia, COVID-19, sepsis, an injury, or a flare-up of a lung condition.

Intensive care supports breathing in steps, depending on how unwell the person is. This may start with extra oxygen, move to a tight-fitting mask that pushes oxygen in (non-invasive ventilation or CPAP), and, if the lungs need more help, to a breathing machine (ventilator) with a tube into the windpipe while the person is sedated.

A severe form of lung failure is called acute respiratory distress syndrome (ARDS), where the lungs become very inflamed. Treatments such as careful ventilator settings, turning the person to lie on their front (prone positioning) and, rarely, a heart-lung bypass machine (ECMO) may be used.

Supporting breathing rests the lungs and keeps oxygen flowing while the cause is treated. It does not cure the lung problem on its own. Many people recover, though it can take time; for some, recovery is partial or, sadly, not possible. The team will keep you updated as things change.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Extra oxygen

Oxygen given through nasal prongs or a mask, or a high-flow device, for people who need more oxygen but can still breathe for themselves.

Non-invasive ventilation (mask)

A tight-fitting mask, including CPAP, that pushes oxygen and air into the lungs to support breathing without a tube, used while the person is awake.

Invasive ventilation (ventilator)

A breathing machine connected to a tube in the windpipe that breathes for the person while they are sedated, used when the lungs need full support.

Prone positioning

Carefully turning the person to lie on their front, which can help more oxygen reach the healthy parts of the lungs in severe failure such as ARDS.

ECMO (heart-lung bypass)

A machine that takes over the work of the lungs by adding oxygen to the blood outside the body, used rarely and only in specialist centres for the most severe cases.

Mask support vs ventilator

Feature	Mask (non-invasive)	Ventilator (invasive)
Breathing tube	No, a tight mask	Yes, into the windpipe
Awake or sedated	Usually awake	Usually sedated
Can speak	Often, between treatments	Not while the tube is in
Used when	Lungs need some help	Lungs need full support

The team starts with the least invasive support that is safe and steps up or down as the person's breathing changes.

Preparing for your treatment

Breathing support is usually started as an emergency, so there is rarely time to prepare.
Ask the team how unwell the lungs are and what support is being used.
Tell staff about any lung conditions, the person's usual medicines and inhalers, and any allergies.
Mention any wishes the person has expressed about ventilation or life support.
Choose one family member as the main contact for updates.
Ask what the plan is, including whether and when weaning off support might begin.

What happens

The team first works out how much help the lungs need and treats the cause — for example antibiotics for an infection. They give the least invasive support that is safe, and step it up if breathing worsens.

If a tight mask is enough, the person stays awake but may find the mask uncomfortable at first. If the lungs need more help, the person is given medicine to send them to sleep (a general anaesthetic), a tube is placed into the windpipe, and a ventilator breathes for them while they are sedated. Settings on the machine are adjusted constantly based on oxygen levels and blood tests.

For severe failure, the person may be turned to lie on their front for periods, and in rare, specialist cases an ECMO machine may take over the lungs' work. Throughout, the person is kept comfortable, and the team reviews progress many times a day, reducing support as the lungs recover.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Full invasive ventilation may not be in someone's best interests if the underlying illness cannot be overcome; the team will discuss this.
Non-invasive masks are not suitable for everyone, for example if someone cannot protect their airway or is too unwell.
If a person has clearly stated they would not want invasive life support, that wish is respected.
Decisions about who is likely to benefit are made by senior clinicians with the family, not by a fixed rule.

Delay or rearrange if…

Breathing support is started without delay in an emergency, so it is not usually postponed.
The team gives the least invasive support that is safe first, stepping up only if needed.
Where the situation is unclear, a trial of support may be agreed and then reviewed honestly.
Families should never feel rushed; ask for time and clear information about the options.

Alternatives to discuss

Extra oxygen alone, for people who need less help.
Non-invasive ventilation (a mask) instead of a tube, in suitable people.
Treating reversible causes, such as infection or fluid on the lungs, which may improve breathing.
Comfort-focused care if invasive treatment can no longer help.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

Sedation

Keeps the person comfortable while on a ventilator and is lightened as the lungs recover and weaning begins.

General anaesthetic

Used to send the person to sleep when a breathing tube is placed for invasive ventilation.

Benefits

Keeps enough oxygen reaching the body when the lungs are failing
Helps clear carbon dioxide that builds up in breathing failure
Rests the lungs and gives treatments time to work on the cause
Can be stepped up or down to match how the person is doing
Keeps the person comfortable while they are most unwell
Allows gradual weaning back to breathing on their own as they recover

Risks & complications

More common

Discomfort from a tight mask, or from a breathing tube and sedation
Muscle weakness from being very ill and still for a time
Confusion or vivid dreams (delirium), which is common in intensive care
A dry or sore throat after a breathing tube is removed

Less common

Chest infections, including pneumonia linked to being on a ventilator
A collapsed lung (pneumothorax) from the lung disease or ventilator pressures
Needing a tracheostomy if breathing support is required for longer
Slow or stepwise weaning, sometimes needing the ventilator restarted

Rare but serious

Lasting lung damage with breathlessness that does not fully recover
Serious complications of severe lung failure that the body cannot overcome
Risks linked to ECMO, such as bleeding or clots, in the rare cases it is used
Death, despite full support, when the lung failure or underlying illness is too severe

The biggest uncertainty is usually whether the lungs and the underlying illness will recover, which varies a great deal between people. The ventilator is life-saving but can itself irritate the lungs, so the team uses careful settings to limit this. Ask which treatments are being used, how the lungs are responding, and what the plan is for weaning.

Published figures to discuss

Survival and recovery from respiratory failure vary widely depending on the cause, its severity, the person's health beforehand and their age. For severe forms such as ARDS, published figures suggest a substantial proportion of people survive, but the range is wide and outcomes differ greatly between patients. The team will give a view tailored to your relative rather than a single fixed figure.

Figure	Reported range	How to interpret it	Source / confidence
Need for escalation from oxygen or NIV to invasive ventilation	Varies widely; higher with pneumonia, ARDS, shock or worsening consciousness	The key safety issue is avoiding both premature intubation and dangerously delayed intubation.	Guide sourcesClinical context
Mortality in severe respiratory failure requiring ICU	High and strongly dependent on cause, age, frailty and other organ failures	Risk should be discussed using the actual diagnosis, such as COPD exacerbation, pneumonia, ARDS or neuromuscular weakness.	NHS — Intensive carenhs.ukSource-linked context
Oxygen causing carbon dioxide retention in susceptible COPD patients	Clinically important	Target oxygen saturations and blood gases matter; more oxygen is not always safer.	Guide sourcesClinical context
Ventilator-associated pneumonia or lung injury	Uncommon to common depending on ventilation duration and severity of illness	Protective ventilation, oral care, sedation minimisation and early weaning reduce avoidable harm.	NHS — Intensive carenhs.ukSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Recovery from severe breathing failure is often slow, and a large part of it happens after intensive care, sometimes over many months. Coming off the ventilator is a gradual, step-by-step process called weaning, not a single moment.

While on support

The team adjusts oxygen and ventilator settings as the lungs change. Progress is often measured in small steps, such as needing a little less oxygen each day.

Weaning off the ventilator

Sedation is lightened and the machine does less of the work, so the person breathes more for themselves. The tube is removed when they can breathe safely on their own.

After the tube comes out

A sore throat and weak voice are common. The person may still need oxygen or a mask at times, and is encouraged to sit up, move and do breathing exercises.

First weeks

Breathlessness on effort, tiredness and weak muscles are normal. Physiotherapy and gradual activity help rebuild strength and lung function.

Months afterwards

Breathing, energy and fitness often keep improving for many months. Some people are left with breathlessness and may benefit from pulmonary rehabilitation.

What's normal — and not a worry

Breathlessness on effort that slowly improves over weeks to months
A sore throat and hoarse voice after a breathing tube is removed
Weak muscles and tiredness as part of recovery from critical illness
Needing oxygen or a mask for a while before managing without
Patchy or muddled memories of the time in intensive care

Aftercare

Pace activity and follow any breathing exercises or physiotherapy plan.
Use oxygen at home exactly as prescribed, if it is needed for a time.
Take lung medicines and inhalers as directed, and keep any chest follow-up.
Stop smoking, and avoid smoky or polluted air, to protect recovering lungs.
Ask about pulmonary rehabilitation if breathlessness is limiting daily life.
Watch for and report signs of a chest infection or worsening breathing.
Talk about frightening memories from intensive care, which are common and can be helped.

Before your treatment

Know whether oxygen or a mask is needed at home, and how to use it
Have a list of lung medicines and inhalers and how to take them
Have any chest clinic or follow-up appointment booked
Ask about pulmonary rehabilitation if breathless
Know the warning signs of a chest infection or worsening breathing
Have contact details for the team and emotional support such as ICUsteps

⚠ Get urgent help if…

Worsening breathlessness, or breathing becoming fast and hard work
Lips or fingertips turning blue or grey
A high temperature, shivering, or coughing up discoloured phlegm or blood
Chest pain or a feeling of tightness that does not ease
Becoming drowsy, confused or hard to wake
Distressing flashbacks or nightmares after intensive care — ask for help early

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good outcome means the lungs recover enough for breathing support to be reduced and stopped, and the person gradually breathes on their own again. This usually becomes clearer over days to weeks. Even after a good recovery, breathlessness, weakness and tiredness can linger for months.

Breathing support cannot guarantee the lungs will recover or that someone will return to exactly how they were before. Some people are left with lasting breathlessness, and for a few the lung failure is too severe to overcome. The team will be honest about what they expect.

How long it lasts

Many people recover good lung function after severe breathing failure, though it can take months and a minority are left with lasting breathlessness. Conditions such as ARDS can affect the lungs and overall fitness for a long time. Pulmonary rehabilitation and stopping smoking help protect recovering lungs. The outlook depends largely on the cause, the person's health beforehand, and how severe the failure was.

Related tests, treatments or support

Treating respiratory failure is usually part of wider intensive care, given alongside support for the heart, kidneys and nutrition, and treatment of the underlying illness. A tracheostomy may be used if breathing support is needed for longer, and physiotherapy is closely involved in weaning and recovery.

Follow-up & long-term care

Many people are reviewed in a chest (respiratory) clinic or an intensive care follow-up clinic after discharge to check lung recovery and arrange any further support, such as pulmonary rehabilitation. The hospital and GP should share information so that lasting breathlessness or other effects are picked up and managed.

Breathing exercises and gradual increases in activity
Pulmonary rehabilitation for ongoing breathlessness
Correct use of any home oxygen or inhalers
Stopping smoking and avoiding lung irritants
Follow-up checks of lung function where needed

Repeat, follow-on and what comes next

Support is constantly adjusted — increased if breathing worsens, reduced as the lungs recover; this is normal.
Weaning off the ventilator may take several attempts, with steps forward and back.
Some people need the ventilator restarted after the tube is removed; this happens and is not a failure.
If breathing support is needed for longer, a tracheostomy may be used to make weaning easier.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

A named contact on the unit and honest, regular updates for the family.
Clear explanations of the breathing support and the weaning plan.
Physiotherapy and early mobilisation to aid lung and muscle recovery.
Chest follow-up and pulmonary rehabilitation for lasting breathlessness.
Emotional support for patient and family, including signposting to ICUsteps.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Treatment of breathing failure is part of NHS intensive care, so families do not usually face a private bill.
Where any private critical care exists, the cost reflects the overall intensive care stay.
The type of support used, from oxygen to a ventilator or ECMO, affects the intensity of care.
How long breathing support is needed varies from days to many weeks.
Specialist nursing, monitoring and round-the-clock cover are major parts of the cost.
Physiotherapy, follow-up and pulmonary rehabilitation form part of later recovery.

Make sure your written quote includes

Confirmation of whether care is NHS or private, and who is responsible for any costs
Who the intensive care consultant in charge is
How decisions about ventilation and escalation will be shared with the family
What happens if more support, a tracheostomy or transfer for ECMO is needed
Whether chest follow-up and rehabilitation are included
How the family will receive updates and who to contact

On the NHS? Treatment of breathing failure in intensive care, including ventilation, is provided by the NHS as urgent care, not as a private self-pay treatment.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the specialist is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good specialist will welcome every one of these.

How severe is my relative's breathing failure, and what is the cause?
What breathing support are you using now, and why?
Are the lungs showing any signs of improving?
What is the plan for weaning off the ventilator?
Might a tracheostomy, prone positioning or ECMO be needed?
What follow-up and rehabilitation will there be after intensive care?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the specialist who carries out my treatment, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this treatment not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Is being on a ventilator the same as being in a coma?

Not quite. People on a ventilator are usually given medicine to keep them asleep and comfortable, but this is controlled by the team and lightened as the lungs recover. It is different from a coma caused by brain injury.

Why can't my relative breathe on their own yet?

Failing lungs and the effort of being critically ill mean the body needs help for a while. As the lungs recover, support is gradually reduced in a process called weaning, until the person can breathe on their own.

What is prone positioning?

It means carefully turning the person to lie on their front for periods. This can help more oxygen reach the healthier parts of the lungs in severe breathing failure, such as ARDS.

What is ECMO, and will my relative need it?

ECMO is a machine that adds oxygen to the blood outside the body, taking over the lungs' work. It is used rarely, only in specialist centres, and only for the most severe cases. Most people do not need it.

Why is recovery so slow even after the ventilator comes off?

Severe lung illness, sedation and being still for a long time weaken the body. Breathlessness, weakness and tiredness can take weeks to months to improve, which is normal.

Can we arrange this privately?

Treatment of breathing failure in intensive care is urgent NHS care, not a private self-pay treatment. The focus is on giving the right support quickly.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Intensive care Asthma + Lung UK — Acute respiratory distress syndrome (ARDS) Faculty of Intensive Care Medicine — What is intensive care? ICUsteps — Intensive care: a guide for patients and relatives Intensive Care Society — Patients and relatives

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.