Respiratory decline is a condition in which medical professionals are responsible for assessing and acting on the moment the patient crosses the line into distress. The tools to intervene, including intubation to take over the work of breathing, exist precisely so that a struggling patient is never left to deteriorate.
Hypercapnia is the accumulation of carbon dioxide in the blood. Carbon dioxide is a waste product that healthy breathing clears with every exhale. When breathing becomes inadequate, whether from heart failure, lung disease, or respiratory muscle fatigue, that carbon dioxide builds up instead of being expelled. As it rises, the blood becomes more acidic and the patient begins to show recognizable signs: confusion, drowsiness, agitation, and worsening respiratory effort.
An anoxic brain injury occurs when the brain is completely deprived of oxygen, causing brain cells to die quickly. Immediate medical attention is vital to restore oxygen and prevent further damage. If an anoxic brain injury accompanies delayed treatment, it can and will cause widespread physical, cognitive, and emotional impacts.
In this case, our client was admitted with signs of respiratory distress and hypercapnia. Further delays in care caused by her physicians ultimately progressed to an anoxic brain injury and cost our client her life. The Townsley Law Firm represented her family and recovered a settlement of over $1,200,000.
Warning Signs the Body Gives Before It Fails
Our client was admitted to a hospital with shortness of breath and swelling, thought to be congestive heart failure. Upon arrival, our client was hypoxic with an O2 saturation that measured 82-percent on room air. She had an elevated pulse, increased blood pressure, and her respirations were labored.
Over the course of her admission, her condition worsened. Her admitting physician ordered an ABG to measure her oxygen and carbon dioxide levels. The order was never carried out because of a known flaw in the hospital’s workflow.
Nine hours later, the next shift discovered the order still hadn’t been done, and when the blood was finally drawn, the result was a critical value.
Throughout the day, our client showed classic signs of CO₂ retention: sweating, lethargy, headache, and dropping oxygen levels. Instead of alerting the physician, staff gave her a fan, a cool cloth, and Tylenol. When her family said she didn’t drink caffeine, nurses insisted her headache was caffeine withdrawal and offered her a soda. Records document her as “very lethargic,” yet her doctor was not urgently notified.
Despite the standard of care calling for close, frequent assessment of a patient in respiratory distress, monitoring blood gases to track carbon dioxide and oxygen levels, and timely escalation to interventions like intubation and mechanical ventilation when the patient is failing, our client was repeatedly neglected and her symptoms went untreated.
The Cost of Waiting Too Long
Intubation, placing a breathing tube and connecting the patient to a ventilator, is the definitive intervention when a patient can no longer breathe adequately on their own.
The intubation that could have supported her breathing did not come when it was needed. Instead of consulting a physician who could intubate her in a controlled safe environment, our client’s doctor allowed her health to decline. Our client eventually became unresponsive, failing to react even to painful stimuli. The attending physician was never physically present at her bedside during those critical overnight hours. He gave ICU and intubation orders by phone and didn’t see her in person until the next morning.
Despite staff already suspecting she would be a difficult intubation, intubation was not arranged until two hours after she became unresponsive. It ultimately took multiple staff members and over an hour of attempts to secure her airway.
Nearly two days after being admitted into the hospital, our client was transferred to another facility where she was officially diagnosed with an anoxic brain injury upon arrival. She never fully recovered from her injuries and ultimately died eight months later.
The difference between the outcome she had and the outcome she should have had was timing. Every patient deserves timely tests, attentive monitoring, and a care team that treats warning signs as warnings, not inconveniences. Every hospital system failure that gets flagged deserves to be fixed before it costs someone their life.
