Pope Francis suffered "two episodes of acute respiratory insufficiency" March 3 but remained alert, the Vatican said, giving cause for concern after two days in which his condition was described as "stable."

The episodes of respiratory distress were "caused by significant accumulation of endobronchial mucus and subsequent bronchospasm," the Vatican said in its evening medical bulletin March 3.

A "respiratory insufficiency" occurs when the lungs are unable to effectively take in sufficient oxygen or expel enough carbon dioxide to meet the body's needs.

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The pope was diagnosed Feb. 18 with pneumonia in both of his lungs, which can contribute to the formation of endobronchial mucus -- the accumulation of mucus in the bronchial tubes, a part of the lungs leading to the airways. Attempting to expel the mucus can lead to a respiratory crisis.

Pope Francis underwent two bronchoscopies March 3, the Vatican said, "with the need for aspiration of abundant secretions," or the removal of excessive mucus or other fluids from the airways during the procedure.

"The Holy Father remained alert, oriented and cooperative at all times," the bulletin said.

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It added that the pope resumed receiving non-invasive mechanical ventilation -- a treatment that delivers air with added oxygen through a tightly fitted face mask using positive pressure to assist breathing. The pope had previously ceased the need for mechanical ventilation and was receiving only high-flow oxygen therapy March 2, the Vatican had said.

The pope's doctors maintained that his prognosis "remains guarded."

Addressing concerns that the pope could develop an infection after inhaling some of his own vomit following another respiratory crisis Feb. 28, a Vatican source said blood tests had continued to show no sign of another developing infection. Previous bulletins said Pope Francis did not show an elevated white blood cell count -- a typical bodily response to infection -- and did not have a fever. 

The respiratory crises suffered March 3 were instead provoked by his already existing infection, the source said.

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Despite the Pope Francis' hospitalization, the Vatican continues to operate. Cardinal Pietro Parolin, Vatican secretary of state, and Archbishop Paul R. Gallagher, the Vatican foreign minister, met at the Vatican with Lithuanian President Gitanas Nauseda and discussed prospects for peace in Ukraine.

U.S.-born Cardinal Robert F. Prevost, prefect of the Dicastery for Bishops, was scheduled to lead the nightly recitation of the rosary for the pope March 3.