Type II respiratory failure can present with hypoxia and carbon dioxide retention and usually requires invasive ventilatory support for carbon dioxide removal. Acute type 2 respiratory failure is most often seen in acute severe infections, and initially presents as hypoxia, i.e., type 1 respiratory failure, with carbon dioxide retention if lung function becomes progressively worse and difficult to reverse. If type II respiratory failure does not improve with invasive ventilatory support, some carbon dioxide removal techniques are required. If the respiratory failure does not improve significantly with carbon dioxide removal techniques, advanced life support is needed to correct type 2 respiratory failure by removing carbon dioxide retention through ECMO, or extracorporeal membrane pulmonary oxygenation.