diff --git a/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml b/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml
index 16aded522b..2f4057cee7 100644
--- a/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml
+++ b/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml
@@ -58,6 +58,9 @@
                         <Label Name="HeartHealthText" Text="{Loc 'health-analyzer-window-entity-heart-health-text'}" />
                         <RichTextLabel Name="HeartHealthLabel" />
                         <TextureButton Name="HeartHealthButton" StyleClasses="SpeciesInfoDefault" Scale="0.3 0.3" VerticalAlignment="Center" />
+                        <Label Name="LungHealthText" Text="{Loc 'health-analyzer-window-entity-lung-health-text'}" />
+                        <RichTextLabel Name="LungHealthLabel" />
+                        <TextureButton Name="LungHealthButton" StyleClasses="SpeciesInfoDefault" Scale="0.3 0.3" VerticalAlignment="Center" />
                         <Label Name="BloodText" Text="{Loc 'health-analyzer-window-entity-blood-level-text'}" />
                         <RichTextLabel Name="BloodLabel" />
                         <TextureButton Name="BloodButton" StyleClasses="SpeciesInfoDefault" Scale="0.3 0.3" VerticalAlignment="Center" />
diff --git a/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml.cs b/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml.cs
index bd8a7d3ee7..52007c15c3 100644
--- a/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml.cs
+++ b/Content.Client/HealthAnalyzer/UI/HealthAnalyzerWindow.xaml.cs
@@ -44,6 +44,7 @@ namespace Content.Client.HealthAnalyzer.UI
         private readonly Tooltips.BloodOxygenationTooltip _bloodOxygenationTooltip = new();
         private readonly Tooltips.HeartRateTooltip _heartRateTooltip = new();
         private readonly Tooltips.HeartHealthTooltip _heartHealthTooltip = new();
+        private readonly Tooltips.LungHealthTooltip _lungHealthTooltip = new();
         private readonly Tooltips.BloodFlowTooltip _bloodFlowTooltip = new();
         private readonly Tooltips.BloodTooltip _bloodTooltip = new();
         private readonly Tooltips.TemperatureTooltip _temperatureTooltip = new();
@@ -71,6 +72,7 @@ namespace Content.Client.HealthAnalyzer.UI
             TemperatureButton.TooltipSupplier = _ => _temperatureTooltip;
             DamageButton.TooltipSupplier = _ => _damageTooltip;
             BloodButton.TooltipSupplier = _ => _bloodTooltip;
+            LungHealthButton.TooltipSupplier = _ => _lungHealthTooltip;
             // End Offbrand
         }
 
@@ -263,6 +265,11 @@ namespace Content.Client.HealthAnalyzer.UI
                 BloodPressureLabel.Text = Loc.GetString("health-analyzer-window-entity-blood-pressure-value", ("systolic", systolic), ("diastolic", diastolic), ("rating", woundable.BloodPressureRating));
                 BloodPressureButton.Visible = true;
 
+                LungHealthText.Visible = true;
+                LungHealthLabel.Visible = true;
+                LungHealthLabel.Text = Loc.GetString("health-analyzer-window-entity-lung-health-value", ("value", $"{woundable.LungHealth * 100:F1}"), ("rating", woundable.LungHealthRating));
+                LungHealthButton.Visible = true;
+
                 BloodLabel.Visible = false;
                 BloodText.Visible = false;
                 BloodButton.Visible = false;
@@ -275,18 +282,21 @@ namespace Content.Client.HealthAnalyzer.UI
                 HeartRateLabel.Visible = false;
                 HeartHealthLabel.Visible = false;
                 BloodFlowLabel.Visible = false;
+                LungHealthLabel.Visible = false;
                 BrainHealthText.Visible = false;
                 BloodPressureText.Visible = false;
                 BloodOxygenationText.Visible = false;
                 BloodFlowText.Visible = false;
                 HeartRateText.Visible = false;
                 HeartHealthText.Visible = false;
+                LungHealthText.Visible = false;
                 BrainHealthButton.Visible = false;
                 BloodPressureButton.Visible = false;
                 BloodOxygenationButton.Visible = false;
                 BloodFlowButton.Visible = false;
                 HeartRateButton.Visible = false;
                 HeartHealthButton.Visible = false;
+                LungHealthButton.Visible = false;
 
                 BloodLabel.Visible = true;
                 BloodText.Visible = true;
diff --git a/Content.Client/HealthAnalyzer/UI/Tooltips/LungHealthTooltip.xaml b/Content.Client/HealthAnalyzer/UI/Tooltips/LungHealthTooltip.xaml
new file mode 100644
index 0000000000..c77cc2662c
--- /dev/null
+++ b/Content.Client/HealthAnalyzer/UI/Tooltips/LungHealthTooltip.xaml
@@ -0,0 +1,8 @@
+<PanelContainer xmlns="https://spacestation14.io" StyleClasses="tooltipBox">
+    <BoxContainer
+        Orientation="Vertical"
+        RectClipContent="True"
+        Margin="4">
+        <RichTextLabel Text="{Loc 'health-analyzer-lung-health-tooltip'}" HorizontalExpand="True" />
+    </BoxContainer>
+</PanelContainer>
diff --git a/Content.Client/HealthAnalyzer/UI/Tooltips/LungHealthTooltip.xaml.cs b/Content.Client/HealthAnalyzer/UI/Tooltips/LungHealthTooltip.xaml.cs
new file mode 100644
index 0000000000..640f9cfd58
--- /dev/null
+++ b/Content.Client/HealthAnalyzer/UI/Tooltips/LungHealthTooltip.xaml.cs
@@ -0,0 +1,15 @@
+using Robust.Client.AutoGenerated;
+using Robust.Client.UserInterface.Controls;
+using Robust.Client.UserInterface.XAML;
+using Robust.Client.UserInterface;
+
+namespace Content.Client.HealthAnalyzer.UI.Tooltips;
+
+[GenerateTypedNameReferences]
+public sealed partial class LungHealthTooltip : PanelContainer
+{
+    public LungHealthTooltip()
+    {
+        RobustXamlLoader.Load(this);
+    }
+}
diff --git a/Content.Server/Body/Systems/RespiratorSystem.cs b/Content.Server/Body/Systems/RespiratorSystem.cs
index 0fa3a492b4..eca008d8f4 100644
--- a/Content.Server/Body/Systems/RespiratorSystem.cs
+++ b/Content.Server/Body/Systems/RespiratorSystem.cs
@@ -140,7 +140,15 @@ public sealed class RespiratorSystem : EntitySystem
         if (ev.Gas is null)
             return;
 
-        var gas = ev.Gas.RemoveVolume(entity.Comp.BreathVolume);
+        // Begin Offbrand
+        var breathEv = new Content.Shared._Offbrand.Wounds.BeforeBreathEvent(entity.Comp.BreathVolume);
+        RaiseLocalEvent(entity, ref breathEv);
+
+        var gas = ev.Gas.RemoveVolume(breathEv.BreathVolume);
+
+        var beforeEv = new Content.Shared._Offbrand.Wounds.BeforeInhaledGasEvent(gas);
+        RaiseLocalEvent(entity, ref beforeEv);
+        // End Offbrand
 
         var inhaleEv = new InhaledGasEvent(gas);
         RaiseLocalEvent(entity, ref inhaleEv);
diff --git a/Content.Server/Zombies/ZombieSystem.Transform.cs b/Content.Server/Zombies/ZombieSystem.Transform.cs
index 32e9a402e0..536679192d 100644
--- a/Content.Server/Zombies/ZombieSystem.Transform.cs
+++ b/Content.Server/Zombies/ZombieSystem.Transform.cs
@@ -170,6 +170,9 @@ public sealed partial class ZombieSystem
             RemComp<CryostasisFactorComponent>(target);
             RemComp<UniqueWoundOnDamageComponent>(target);
             RemComp<IntrinsicPainComponent>(target);
+            RemComp<LungDamageComponent>(target);
+            RemComp<LungDamageOnInhaledAirTemperatureComponent>(target);
+            RemComp<LungDamageAlertsComponent>(target);
 
             var entProto = _protoManager.Index(AddOnWoundableZombified);
             EntityManager.RemoveComponents(target, entProto.Components);
diff --git a/Content.Server/_Offbrand/Wounds/LungDamageTemperatureSystem.cs b/Content.Server/_Offbrand/Wounds/LungDamageTemperatureSystem.cs
new file mode 100644
index 0000000000..cc97ecfe42
--- /dev/null
+++ b/Content.Server/_Offbrand/Wounds/LungDamageTemperatureSystem.cs
@@ -0,0 +1,35 @@
+using Content.Server.Temperature.Components;
+using Content.Shared._Offbrand.Wounds;
+
+namespace Content.Server._Offbrand.Wounds;
+
+public sealed class LungDamageTemperatureSystem : EntitySystem
+{
+    [Dependency] private readonly LungDamageSystem _lungDamage = default!;
+
+    public override void Initialize()
+    {
+        base.Initialize();
+
+        SubscribeLocalEvent<LungDamageOnInhaledAirTemperatureComponent, BeforeInhaledGasEvent>(OnBeforeInhaledGas);
+    }
+
+    private void OnBeforeInhaledGas(Entity<LungDamageOnInhaledAirTemperatureComponent> ent, ref BeforeInhaledGasEvent args)
+    {
+        var temperature = Comp<TemperatureComponent>(ent);
+
+        var heatDamageThreshold = temperature.ParentHeatDamageThreshold ?? temperature.HeatDamageThreshold;
+        var coldDamageThreshold = temperature.ParentColdDamageThreshold ?? temperature.ColdDamageThreshold;
+
+        if (args.Gas.Temperature >= heatDamageThreshold)
+        {
+            var damage = ent.Comp.HeatCoefficient * args.Gas.Temperature + ent.Comp.HeatConstant;
+            _lungDamage.TryModifyDamage(ent.Owner, damage);
+        }
+        else if (args.Gas.Temperature <= coldDamageThreshold)
+        {
+            var damage = ent.Comp.ColdCoefficient * args.Gas.Temperature + ent.Comp.ColdConstant;
+            _lungDamage.TryModifyDamage(ent.Owner, damage);
+        }
+    }
+}
diff --git a/Content.Shared/_Offbrand/EntityEffects/LungDamage.cs b/Content.Shared/_Offbrand/EntityEffects/LungDamage.cs
new file mode 100644
index 0000000000..7c9e8584ac
--- /dev/null
+++ b/Content.Shared/_Offbrand/EntityEffects/LungDamage.cs
@@ -0,0 +1,32 @@
+using Content.Shared._Offbrand.Wounds;
+using Content.Shared.EntityEffects;
+using Content.Shared.FixedPoint;
+using Robust.Shared.Prototypes;
+
+namespace Content.Shared._Offbrand.EntityEffects;
+
+public sealed partial class LungDamage : EntityEffectCondition
+{
+    [DataField]
+    public FixedPoint2 Max = FixedPoint2.MaxValue;
+
+    [DataField]
+    public FixedPoint2 Min = FixedPoint2.Zero;
+
+    public override bool Condition(EntityEffectBaseArgs args)
+    {
+        if (args.EntityManager.TryGetComponent<LungDamageComponent>(args.TargetEntity, out var lungDamage))
+        {
+            return lungDamage.Damage >= Min && lungDamage.Damage <= Max;
+        }
+
+        return false;
+    }
+
+    public override string GuidebookExplanation(IPrototypeManager prototype)
+    {
+        return Loc.GetString("reagent-effect-condition-guidebook-lung-damage",
+            ("max", Max == FixedPoint2.MaxValue ? (float) int.MaxValue : Max.Float()),
+            ("min", Min.Float()));
+    }
+}
diff --git a/Content.Shared/_Offbrand/EntityEffects/ModifyLungDamage.cs b/Content.Shared/_Offbrand/EntityEffects/ModifyLungDamage.cs
new file mode 100644
index 0000000000..ae1d579ba5
--- /dev/null
+++ b/Content.Shared/_Offbrand/EntityEffects/ModifyLungDamage.cs
@@ -0,0 +1,31 @@
+using Content.Shared._Offbrand.Wounds;
+using Content.Shared.EntityEffects;
+using Content.Shared.FixedPoint;
+using Robust.Shared.Prototypes;
+
+namespace Content.Shared._Offbrand.EntityEffects;
+
+public sealed partial class ModifyLungDamage : EntityEffect
+{
+    [DataField(required: true)]
+    public FixedPoint2 Amount;
+
+    protected override string ReagentEffectGuidebookText(IPrototypeManager prototype, IEntitySystemManager entSys)
+    {
+        if (Amount < FixedPoint2.Zero)
+            return Loc.GetString("reagent-effect-guidebook-modify-lung-damage-heals", ("chance", Probability), ("amount", -Amount));
+        else
+            return Loc.GetString("reagent-effect-guidebook-modify-lung-damage-deals", ("chance", Probability), ("amount", Amount));
+    }
+
+    public override void Effect(EntityEffectBaseArgs args)
+    {
+        var scale = FixedPoint2.New(1);
+
+        if (args is EntityEffectReagentArgs reagentArgs)
+            scale = reagentArgs.Scale;
+
+        args.EntityManager.System<LungDamageSystem>()
+            .TryModifyDamage(args.TargetEntity, Amount * scale);
+    }
+}
diff --git a/Content.Shared/_Offbrand/Surgery/ChangeLungDamage.cs b/Content.Shared/_Offbrand/Surgery/ChangeLungDamage.cs
new file mode 100644
index 0000000000..fae2ac21f0
--- /dev/null
+++ b/Content.Shared/_Offbrand/Surgery/ChangeLungDamage.cs
@@ -0,0 +1,17 @@
+using Content.Shared._Offbrand.Wounds;
+using Content.Shared.Construction;
+using Content.Shared.FixedPoint;
+
+namespace Content.Shared._Offbrand.Surgery;
+
+[DataDefinition]
+public sealed partial class ChangeLungDamage : IGraphAction
+{
+    [DataField(required: true)]
+    public FixedPoint2 Amount;
+
+    public void PerformAction(EntityUid uid, EntityUid? userUid, IEntityManager entityManager)
+    {
+        entityManager.System<LungDamageSystem>().TryModifyDamage(uid, Amount);
+    }
+}
diff --git a/Content.Shared/_Offbrand/Surgery/LungDamage.cs b/Content.Shared/_Offbrand/Surgery/LungDamage.cs
new file mode 100644
index 0000000000..d99595ac9a
--- /dev/null
+++ b/Content.Shared/_Offbrand/Surgery/LungDamage.cs
@@ -0,0 +1,47 @@
+using Content.Shared._Offbrand.Wounds;
+using Content.Shared.Construction;
+using Content.Shared.Examine;
+using Content.Shared.FixedPoint;
+using Robust.Shared.Prototypes;
+
+namespace Content.Shared._Offbrand.Surgery;
+
+[DataDefinition]
+public sealed partial class LungDamage : IGraphCondition
+{
+    [DataField]
+    public FixedPoint2 Max = FixedPoint2.MaxValue;
+
+    [DataField]
+    public FixedPoint2 Min = FixedPoint2.Zero;
+
+    public bool Condition(EntityUid uid, IEntityManager entityManager)
+    {
+        if (!entityManager.TryGetComponent<LungDamageComponent>(uid, out var lungDamage))
+            return false;
+
+        return lungDamage.Damage >= Min && lungDamage.Damage <= Max;
+    }
+
+    public bool DoExamine(ExaminedEvent args)
+    {
+        if (!IoCManager.Resolve<IEntityManager>().TryGetComponent<LungDamageComponent>(args.Examined, out var lungDamage))
+            return false;
+
+        if (lungDamage.Damage >= Min && lungDamage.Damage <= Max)
+            return false;
+
+        args.PushMarkup(Loc.GetString("construction-examine-lung-damage-range", ("min", Min.Float()), ("max", Max == FixedPoint2.MaxValue ? (float) int.MaxValue : Max.Float())));
+        return true;
+    }
+
+    public IEnumerable<ConstructionGuideEntry> GenerateGuideEntry()
+    {
+        yield return new ConstructionGuideEntry()
+        {
+            Localization = "construction-step-lung-damage-range",
+            Arguments =
+                [ ("min", Min.Float()), ("max", Max == FixedPoint2.MaxValue ? (float) int.MaxValue : Max.Float()) ],
+        };
+    }
+}
diff --git a/Content.Shared/_Offbrand/Wounds/LungDamageComponent.cs b/Content.Shared/_Offbrand/Wounds/LungDamageComponent.cs
new file mode 100644
index 0000000000..4704b43923
--- /dev/null
+++ b/Content.Shared/_Offbrand/Wounds/LungDamageComponent.cs
@@ -0,0 +1,92 @@
+using Content.Shared.Alert;
+using Content.Shared.Atmos;
+using Content.Shared.FixedPoint;
+using Robust.Shared.GameStates;
+using Robust.Shared.Prototypes;
+
+namespace Content.Shared._Offbrand.Wounds;
+
+[RegisterComponent, NetworkedComponent, AutoGenerateComponentState]
+[Access(typeof(LungDamageSystem))]
+public sealed partial class LungDamageComponent : Component
+{
+    /// <summary>
+    /// The maximum amount of damage this entity's lungs can take
+    /// </summary>
+    [DataField(required: true)]
+    public FixedPoint2 MaxDamage;
+
+    /// <summary>
+    /// The current amount of accrued damage
+    /// </summary>
+    [DataField(required: true), AutoNetworkedField]
+    public FixedPoint2 Damage;
+}
+
+[RegisterComponent, NetworkedComponent, AutoGenerateComponentState]
+[Access(typeof(LungDamageSystem))]
+public sealed partial class LungDamageAlertsComponent : Component
+{
+    /// <summary>
+    /// The alert to display depending on the amount of lung damage. Highest key is selected.
+    /// </summary>
+    [DataField(required: true)]
+    public SortedDictionary<FixedPoint2, ProtoId<AlertPrototype>> AlertThresholds;
+
+    /// <summary>
+    /// The alert category of the alerts.
+    /// </summary>
+    [DataField(required: true)]
+    public ProtoId<AlertCategoryPrototype> AlertCategory;
+
+    [DataField, AutoNetworkedField]
+    public ProtoId<AlertPrototype>? CurrentAlertThresholdState;
+}
+
+[RegisterComponent, NetworkedComponent]
+public sealed partial class LungDamageOnInhaledAirTemperatureComponent : Component
+{
+    /// <summary>
+    /// The coefficient for how much damage is taken when the air temperature is below <see cref="TemperatureComponent"/>'s ColdDamageThreshold
+    /// </summary>
+    [DataField(required: true)]
+    public float ColdCoefficient;
+
+    /// <summary>
+    /// The constant for how much damage is taken when the air temperature is below <see cref="TemperatureComponent"/>'s ColdDamageThreshold
+    /// </summary>
+    [DataField(required: true)]
+    public float ColdConstant;
+
+    /// <summary>
+    /// The coefficient for how much damage is taken when the air temperature is below <see cref="TemperatureComponent"/>'s HeatDamageThreshold
+    /// </summary>
+    [DataField(required: true)]
+    public float HeatCoefficient;
+
+    /// <summary>
+    /// The constant for how much damage is taken when the air temperature is below <see cref="TemperatureComponent"/>'s HeatDamageThreshold
+    /// </summary>
+    [DataField(required: true)]
+    public float HeatConstant;
+}
+
+/// <summary>
+/// Event raised when an entity is about to take a breath
+/// </summary>
+/// <param name="BreathVolume">The volume to breathe in.</param>
+[ByRefEvent]
+public record struct BeforeBreathEvent(float BreathVolume);
+
+/// <summary>
+/// Event raised when an entity successfully inhales a gas, before storing the gas internally
+/// </summary>
+/// <param name="Gas">The gas we're inhaling.</param>
+[ByRefEvent]
+public record struct BeforeInhaledGasEvent(GasMixture Gas);
+
+/// <summary>
+/// Event raised when an entity's lung damage changes
+/// </summary>
+[ByRefEvent]
+public record struct AfterLungDamageChangedEvent;
diff --git a/Content.Shared/_Offbrand/Wounds/LungDamageSystem.cs b/Content.Shared/_Offbrand/Wounds/LungDamageSystem.cs
new file mode 100644
index 0000000000..fee02f1459
--- /dev/null
+++ b/Content.Shared/_Offbrand/Wounds/LungDamageSystem.cs
@@ -0,0 +1,69 @@
+using Content.Shared.Alert;
+using Content.Shared.FixedPoint;
+using Content.Shared.Rejuvenate;
+
+namespace Content.Shared._Offbrand.Wounds;
+
+public sealed class LungDamageSystem : EntitySystem
+{
+    [Dependency] private readonly AlertsSystem _alerts = default!;
+
+    public override void Initialize()
+    {
+        base.Initialize();
+
+        SubscribeLocalEvent<LungDamageComponent, BeforeBreathEvent>(OnBeforeBreath);
+        SubscribeLocalEvent<LungDamageComponent, RejuvenateEvent>(OnRejuvenate);
+        SubscribeLocalEvent<LungDamageAlertsComponent, AfterLungDamageChangedEvent>(OnLungDamageChanged);
+        SubscribeLocalEvent<LungDamageAlertsComponent, ComponentShutdown>(OnAlertsShutdown);
+    }
+
+    private void OnBeforeBreath(Entity<LungDamageComponent> ent, ref BeforeBreathEvent args)
+    {
+        args.BreathVolume *= 1f - MathF.Pow(ent.Comp.Damage.Float() / ent.Comp.MaxDamage.Float(), 3f);
+    }
+
+    public void TryModifyDamage(Entity<LungDamageComponent?> ent, FixedPoint2 damage)
+    {
+        if (!Resolve(ent, ref ent.Comp))
+            return;
+
+        ent.Comp.Damage = FixedPoint2.Clamp(ent.Comp.Damage + damage, FixedPoint2.Zero, ent.Comp.MaxDamage);
+        Dirty(ent);
+
+        var evt = new AfterLungDamageChangedEvent();
+        RaiseLocalEvent(ent, ref evt);
+    }
+
+    private void OnRejuvenate(Entity<LungDamageComponent> ent, ref RejuvenateEvent args)
+    {
+        ent.Comp.Damage = FixedPoint2.Zero;
+        Dirty(ent);
+
+        var evt = new AfterLungDamageChangedEvent();
+        RaiseLocalEvent(ent, ref evt);
+    }
+
+    private void OnLungDamageChanged(Entity<LungDamageAlertsComponent> ent, ref AfterLungDamageChangedEvent args)
+    {
+        var lungDamage = Comp<LungDamageComponent>(ent);
+        var targetAlert = ent.Comp.AlertThresholds.HighestMatch(lungDamage.Damage);
+
+        if (targetAlert == ent.Comp.CurrentAlertThresholdState)
+            return;
+
+        if (targetAlert is { } alert)
+        {
+            _alerts.ShowAlert(ent.Owner, alert);
+        }
+        else
+        {
+            _alerts.ClearAlertCategory(ent.Owner, ent.Comp.AlertCategory);
+        }
+    }
+
+    private void OnAlertsShutdown(Entity<LungDamageAlertsComponent> ent, ref ComponentShutdown args)
+    {
+        _alerts.ClearAlertCategory(ent.Owner, ent.Comp.AlertCategory);
+    }
+}
diff --git a/Content.Shared/_Offbrand/Wounds/WoundableHealthAnalyzer.cs b/Content.Shared/_Offbrand/Wounds/WoundableHealthAnalyzer.cs
index 56d7a8e56a..ec152fde96 100644
--- a/Content.Shared/_Offbrand/Wounds/WoundableHealthAnalyzer.cs
+++ b/Content.Shared/_Offbrand/Wounds/WoundableHealthAnalyzer.cs
@@ -45,6 +45,12 @@ public sealed partial class WoundableHealthAnalyzerData
     [DataField]
     public AttributeRating HeartRateRating;
 
+    [DataField]
+    public double LungHealth;
+
+    [DataField]
+    public AttributeRating LungHealthRating;
+
     [DataField]
     public bool AnyVitalCritical;
 
@@ -124,8 +130,12 @@ public abstract class SharedWoundableHealthAnalyzerSystem : EntitySystem
         if (!TryComp<BrainDamageComponent>(uid, out var brainDamage))
             return null;
 
+        if (!TryComp<LungDamageComponent>(uid, out var lungDamage))
+            return null;
+
         var brainHealth = 1d - ((double)brainDamage.Damage / (double)brainDamage.MaxDamage);
         var heartHealth = 1d - ((double)heartrate.Damage / (double)heartrate.MaxDamage);
+        var lungHealth = 1d - ((double)lungDamage.Damage / (double)lungDamage.MaxDamage);
         var strain = _heart.HeartStrain((uid, heartrate)).Double() / 4d;
         var (upper, lower) = _heart.BloodPressure((uid, heartrate));
         var oxygenation = _heart.BloodOxygenation((uid, heartrate)).Double();
@@ -149,6 +159,8 @@ public abstract class SharedWoundableHealthAnalyzerSystem : EntitySystem
                 BloodFlowRating = RateHigherIsBetter(flow),
                 HeartRate = _heart.HeartRate((uid, heartrate)).Int(),
                 HeartRateRating = !heartrate.Running ? AttributeRating.Dangerous : RateHigherIsWorse(strain),
+                LungHealth = lungHealth,
+                LungHealthRating = RateHigherIsBetter(lungHealth),
                 AnyVitalCritical = _shockThresholds.IsCritical(uid) || _brainDamage.IsCritical(uid) || _heart.IsCritical(uid),
                 Wounds = withWounds ? SampleWounds(uid) : null,
                 Reagents = reagents,
diff --git a/Resources/Locale/en-US/_Offbrand/alerts.ftl b/Resources/Locale/en-US/_Offbrand/alerts.ftl
index 0f68a68766..7eed45485f 100644
--- a/Resources/Locale/en-US/_Offbrand/alerts.ftl
+++ b/Resources/Locale/en-US/_Offbrand/alerts.ftl
@@ -33,3 +33,12 @@ alerts-critical-brain-damage-desc = Your brain cannot control your body.
 
 alerts-brain-death-name = [color=crimson]Brain Dead[/color]
 alerts-brain-death-desc = Your brain has faded away into nothingness.
+
+alerts-minor-lung-damage-name = [color=yellow]Minor Lung Damage[/color]
+alerts-minor-lung-damage-desc = Your lungs have taken minor damage. Turn up the pressure on your internals and seek care.
+
+alerts-severe-lung-damage-name = [color=red]Severe Lung Damage[/color]
+alerts-severe-lung-damage-desc = Your lungs are struggling to breathe. Turn up the pressure on your internals and seek care promptly.
+
+alerts-critical-lung-damage-name = [color=crimson]Lung Failure[/color]
+alerts-critical-lung-damage-desc = You cannot breathe well if at all. Seek care promptly.
diff --git a/Resources/Locale/en-US/_Offbrand/construction.ftl b/Resources/Locale/en-US/_Offbrand/construction.ftl
index 6c1beeeffa..fa4a368df9 100644
--- a/Resources/Locale/en-US/_Offbrand/construction.ftl
+++ b/Resources/Locale/en-US/_Offbrand/construction.ftl
@@ -21,4 +21,20 @@ construction-step-heart-damage-range = { $max ->
              }
 }
 
+construction-examine-lung-damage-range = { $max ->
+    [2147483648] The target needs to have at least {NATURALFIXED($min, 2)} lung damage.
+    *[other] { $min ->
+                [0] The target needs to have at most {NATURALFIXED($max, 2)} lung damage.
+                *[other] The target needs to have between {NATURALFIXED($min, 2)} and {NATURALFIXED($max, 2)} lung damage.
+             }
+}
+
+construction-step-lung-damage-range = { $max ->
+    [2147483648] The target needs to have at least {NATURALFIXED($min, 2)} lung damage.
+    *[other] { $min ->
+                [0] The target needs to have at most {NATURALFIXED($max, 2)} lung damage.
+                *[other] The target needs to have between {NATURALFIXED($min, 2)} and {NATURALFIXED($max, 2)} lung damage.
+             }
+}
+
 construction-component-to-perform-header = To perform {$targetName}...
diff --git a/Resources/Locale/en-US/_Offbrand/effects.ftl b/Resources/Locale/en-US/_Offbrand/effects.ftl
index 39ed12a032..425c6d8290 100644
--- a/Resources/Locale/en-US/_Offbrand/effects.ftl
+++ b/Resources/Locale/en-US/_Offbrand/effects.ftl
@@ -24,6 +24,14 @@ reagent-effect-guidebook-modify-heart-damage-deals = { $chance ->
         [1] Deals { $amount } heart damage
    *[other] deal { $amount } heart damage
 }
+reagent-effect-guidebook-modify-lung-damage-heals = { $chance ->
+        [1] Heals { $amount } lung health
+   *[other] heal { $amount } lung health
+}
+reagent-effect-guidebook-modify-lung-damage-deals = { $chance ->
+        [1] Deals { $amount } lung damage
+   *[other] deal { $amount } lung damage
+}
 reagent-effect-guidebook-clamp-wounds = { $probability ->
         [1] Stops bleeding in wounds with { NATURALPERCENT($chance, 2) } chance per wound
    *[other] stop bleeding in wounds with { NATURALPERCENT($chance, 2) } chance per wound
@@ -35,6 +43,13 @@ reagent-effect-condition-guidebook-heart-damage = { $max ->
                 *[other] it has between {NATURALFIXED($min, 2)} and {NATURALFIXED($max, 2)} heart damage
              }
 }
+reagent-effect-condition-guidebook-lung-damage = { $max ->
+    [2147483648] it has at least {NATURALFIXED($min, 2)} lung damage
+    *[other] { $min ->
+                [0] it has at most {NATURALFIXED($max, 2)} lung damage
+                *[other] it has between {NATURALFIXED($min, 2)} and {NATURALFIXED($max, 2)} lung damage
+             }
+}
 reagent-effect-condition-guidebook-brain-damage = { $max ->
     [2147483648] it has at least {NATURALFIXED($min, 2)} brain damage
     *[other] { $min ->
diff --git a/Resources/Locale/en-US/_Offbrand/health-analyzer.ftl b/Resources/Locale/en-US/_Offbrand/health-analyzer.ftl
index c07c54431f..d7c4a3f0d9 100644
--- a/Resources/Locale/en-US/_Offbrand/health-analyzer.ftl
+++ b/Resources/Locale/en-US/_Offbrand/health-analyzer.ftl
@@ -14,9 +14,11 @@ health-analyzer-window-entity-blood-oxygenation-text = Blood Saturation:
 health-analyzer-window-entity-blood-flow-text = Blood Flow:
 health-analyzer-window-entity-heart-rate-text = Heart Rate:
 health-analyzer-window-entity-heart-health-text = Heart Health:
+health-analyzer-window-entity-lung-health-text = Lung Health:
 
 health-analyzer-window-entity-brain-health-value = {$value}% { -health-analyzer-rating(rating: $rating) }
 health-analyzer-window-entity-heart-health-value = {$value}% { -health-analyzer-rating(rating: $rating) }
+health-analyzer-window-entity-lung-health-value = {$value}% { -health-analyzer-rating(rating: $rating) }
 health-analyzer-window-entity-heart-rate-value = {$value}bpm { -health-analyzer-rating(rating: $rating) }
 health-analyzer-window-entity-blood-oxygenation-value = {$value}% { -health-analyzer-rating(rating: $rating) }
 health-analyzer-window-entity-blood-pressure-value = {$systolic}/{$diastolic} { -health-analyzer-rating(rating: $rating) }
@@ -101,6 +103,13 @@ health-analyzer-cryostasis-temperature-tooltip =
 
     This temperature has a cryostasis factor of {$factor}%.
 
+health-analyzer-lung-health-tooltip =
+    The patient's lung health.
+
+    The lower this number, the more difficulty they have breathing.
+
+    If the lung health is low, consider putting the patient on higher-pressure internals.
+
 health-analyzer-blood-tooltip =
     The patient's blood volume.
 
diff --git a/Resources/Locale/en-US/_Offbrand/surgery.ftl b/Resources/Locale/en-US/_Offbrand/surgery.ftl
index c3a83b89e4..07cbf831dd 100644
--- a/Resources/Locale/en-US/_Offbrand/surgery.ftl
+++ b/Resources/Locale/en-US/_Offbrand/surgery.ftl
@@ -14,6 +14,12 @@ surgery-heart-treatment-suture-desc = Treats heart damage.
 surgery-heart-treatment-medicated-suture-name = heart treatment (medicated sutures)
 surgery-heart-treatment-medicated-suture-desc = Treats heart damage.
 
+surgery-lung-treatment-suture-name = lung treatment (sutures)
+surgery-lung-treatment-suture-desc = Treats lung damage.
+
+surgery-lung-treatment-medicated-suture-name = lung treatment (medicated sutures)
+surgery-lung-treatment-medicated-suture-desc = Treats lung damage.
+
 surgery-husking-treatment-name = husking treatment
 surgery-husking-treatment-desc = Reconstructs a husked body.
 
diff --git a/Resources/Prototypes/Alerts/alerts.yml b/Resources/Prototypes/Alerts/alerts.yml
index f65bc231d3..8ac9c25ec4 100644
--- a/Resources/Prototypes/Alerts/alerts.yml
+++ b/Resources/Prototypes/Alerts/alerts.yml
@@ -7,6 +7,7 @@
     - category: Health
     - category: Pain # Offbrand
     - category: BrainDamage # Offbrand
+    - category: LungDamage # Offbrand
     - category: Stamina
     - alertType: SuitPower
     - category: Internals
diff --git a/Resources/Prototypes/Entities/Mobs/Species/base.yml b/Resources/Prototypes/Entities/Mobs/Species/base.yml
index f16b8c698a..f2b55df2aa 100644
--- a/Resources/Prototypes/Entities/Mobs/Species/base.yml
+++ b/Resources/Prototypes/Entities/Mobs/Species/base.yml
@@ -224,6 +224,7 @@
   - BaseMobHeartrate # Offbrand
   - BaseMobBrain # Offbrand
   - BaseMobCryostasis # Offbrand
+  - BaseMobLungDamage # Offbrand
   id: BaseMobSpeciesOrganic
   abstract: true
   components:
diff --git a/Resources/Prototypes/Reagents/medicine.yml b/Resources/Prototypes/Reagents/medicine.yml
index 5ba4345b99..e3d3161356 100644
--- a/Resources/Prototypes/Reagents/medicine.yml
+++ b/Resources/Prototypes/Reagents/medicine.yml
@@ -202,6 +202,11 @@
         conditions:
         - !type:Temperature
           max: 213.0
+      - !type:ModifyLungDamage
+        amount: -0.3
+        conditions:
+        - !type:Temperature
+          max: 213.0
       - !type:EvenHealthChange
         conditions:
         - !type:Temperature
diff --git a/Resources/Prototypes/Reagents/toxins.yml b/Resources/Prototypes/Reagents/toxins.yml
index c576082b83..299bcdca19 100644
--- a/Resources/Prototypes/Reagents/toxins.yml
+++ b/Resources/Prototypes/Reagents/toxins.yml
@@ -339,6 +339,8 @@
         damage:
           groups:
             Airloss: 10
+      - !type:ModifyLungDamage # Offbrand
+        amount: 2
 
 - type: reagent
   id: MindbreakerToxin
@@ -515,6 +517,11 @@
         conditions:
         - !type:MetaboliteThreshold
           min: 15
+      - !type:ModifyLungDamage
+        amount: 0.1
+        conditions:
+        - !type:MetaboliteThreshold
+          min: 15
       - !type:AdjustTemperature
         amount: 3000
         conditions:
diff --git a/Resources/Prototypes/_Offbrand/alerts.yml b/Resources/Prototypes/_Offbrand/alerts.yml
index ca2d6eb300..81cde1aae2 100644
--- a/Resources/Prototypes/_Offbrand/alerts.yml
+++ b/Resources/Prototypes/_Offbrand/alerts.yml
@@ -32,6 +32,36 @@
 - type: alertCategory
   id: BrainDamage
 
+- type: alertCategory
+  id: LungDamage
+
+- type: alert
+  id: MinorLungDamage
+  category: LungDamage
+  icons:
+  - sprite: /Textures/_Offbrand/Alerts/lung_damage.rsi
+    state: minor
+  name: alerts-minor-lung-damage-name
+  description: alerts-minor-lung-damage-desc
+
+- type: alert
+  id: SevereLungDamage
+  category: LungDamage
+  icons:
+  - sprite: /Textures/_Offbrand/Alerts/lung_damage.rsi
+    state: severe
+  name: alerts-severe-lung-damage-name
+  description: alerts-severe-lung-damage-desc
+
+- type: alert
+  id: CriticalLungDamage
+  category: LungDamage
+  icons:
+  - sprite: /Textures/_Offbrand/Alerts/lung_damage.rsi
+    state: critical
+  name: alerts-critical-lung-damage-name
+  description: alerts-critical-lung-damage-desc
+
 - type: alert
   id: SuppressedPain
   category: Pain
diff --git a/Resources/Prototypes/_Offbrand/base_mob.yml b/Resources/Prototypes/_Offbrand/base_mob.yml
index b8ca40b6bf..e11fb0798a 100644
--- a/Resources/Prototypes/_Offbrand/base_mob.yml
+++ b/Resources/Prototypes/_Offbrand/base_mob.yml
@@ -297,3 +297,22 @@
   - type: CryostasisFactor
     temperatureCoefficient: -0.059
     temperatureConstant: 19
+
+- type: entity
+  abstract: true
+  id: BaseMobLungDamage
+  components:
+  - type: LungDamage
+    damage: 0
+    maxDamage: 100
+  - type: LungDamageOnInhaledAirTemperature
+    heatCoefficient: 0.005
+    heatConstant: -1.375
+    coldCoefficient: -0.01
+    coldConstant: 3
+  - type: LungDamageAlerts
+    alertThresholds:
+      15: MinorLungDamage
+      40: SevereLungDamage
+      60: CriticalLungDamage
+    alertCategory: LungDamage
diff --git a/Resources/Prototypes/_Offbrand/reagents.yml b/Resources/Prototypes/_Offbrand/reagents.yml
index 83013318c4..ae17ccacee 100644
--- a/Resources/Prototypes/_Offbrand/reagents.yml
+++ b/Resources/Prototypes/_Offbrand/reagents.yml
@@ -169,6 +169,11 @@
         conditions:
         - !type:HeartDamage
           max: 25
+      - !type:ModifyLungDamage
+        amount: -0.2
+        conditions:
+        - !type:LungDamage
+          max: 50
       - !type:HealthChange
         conditions:
         - !type:ReagentThreshold
@@ -211,6 +216,11 @@
         conditions:
         - !type:Temperature
           max: 170.0
+      - !type:ModifyLungDamage
+        amount: -0.6
+        conditions:
+        - !type:Temperature
+          max: 170.0
       - !type:EvenHealthChange
         conditions:
         - !type:Temperature
@@ -336,7 +346,7 @@
         - !type:TotalGroupDamage
           group: Airloss
           min: 4
-      - !type:ModifyHeartDamage
+      - !type:ModifyLungDamage
         amount: 0.05
 
 - type: reagent
diff --git a/Resources/Prototypes/_Offbrand/surgery_constructions.yml b/Resources/Prototypes/_Offbrand/surgery_constructions.yml
index 3a7488a333..db7a5af37c 100644
--- a/Resources/Prototypes/_Offbrand/surgery_constructions.yml
+++ b/Resources/Prototypes/_Offbrand/surgery_constructions.yml
@@ -31,6 +31,28 @@
   category: Surgery
   objectType: NodeToNode
 
+- type: construction
+  hide: true
+  id: LungTreatmentSuture
+  name: surgery-lung-treatment-suture-name
+  description: surgery-lung-treatment-suture-desc
+  graph: SurgeryGraph
+  startNode: Base
+  targetNode: LungTreatmentSuture
+  category: Surgery
+  objectType: NodeToNode
+
+- type: construction
+  hide: true
+  id: LungTreatmentMedicatedSuture
+  name: surgery-lung-treatment-medicated-suture-name
+  description: surgery-lung-treatment-medicated-suture-desc
+  graph: SurgeryGraph
+  startNode: Base
+  targetNode: LungTreatmentMedicatedSuture
+  category: Surgery
+  objectType: NodeToNode
+
 - type: construction
   hide: true
   id: HuskingTreatment
diff --git a/Resources/Prototypes/_Offbrand/surgery_graph.yml b/Resources/Prototypes/_Offbrand/surgery_graph.yml
index b095b6cfa3..ce2fc0fd8f 100644
--- a/Resources/Prototypes/_Offbrand/surgery_graph.yml
+++ b/Resources/Prototypes/_Offbrand/surgery_graph.yml
@@ -157,6 +157,36 @@
       steps:
       - tool: Drilling
         doAfter: 2
+    - to: OpenRibCageRecoupling
+      steps:
+      - tool: Recoupling
+        doAfter: 1
+  - node: OpenRibCageRecoupling
+    edges:
+    - to: OpenRibCage
+      steps:
+      - tool: Clamping
+        doAfter: 1
+    - to: LungTreatmentSuture
+      conditions: &lung-damage-conditions
+      - !type:LungDamage
+        min: 1
+      completed:
+      - !type:ChangeLungDamage
+        amount: -5
+      steps:
+      - material: Suture
+        amount: 1
+        doAfter: 5
+    - to: LungTreatmentMedicatedSuture
+      conditions: *lung-damage-conditions
+      completed:
+      - !type:ChangeLungDamage
+        amount: -10
+      steps:
+      - material: MedicatedSuture
+        amount: 1
+        doAfter: 3
   - node: OpenRibCageMending
     edges:
     - to: OpenRibCageSetting
@@ -204,6 +234,20 @@
     - !type:SetNode
       node: OpenRibCage
       repeatConditions: *heart-damage-conditions
+  - node: LungTreatmentSuture
+    header: construction-component-to-perform-header
+    localizedName: surgery-lung-treatment-suture-name
+    actions:
+    - !type:SetNode
+      node: OpenRibCageRecoupling
+      repeatConditions: *lung-damage-conditions
+  - node: LungTreatmentMedicatedSuture
+    header: construction-component-to-perform-header
+    localizedName: surgery-lung-treatment-medicated-suture-name
+    actions:
+    - !type:SetNode
+      node: OpenRibCageRecoupling
+      repeatConditions: *lung-damage-conditions
   - node: HuskingTreatment
     header: construction-component-to-perform-header
     localizedName: surgery-husking-treatment-name
diff --git a/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/critical.png b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/critical.png
new file mode 100644
index 0000000000..0b0db1a13d
Binary files /dev/null and b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/critical.png differ
diff --git a/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/meta.json b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/meta.json
new file mode 100644
index 0000000000..892d7abd53
--- /dev/null
+++ b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/meta.json
@@ -0,0 +1,20 @@
+{
+    "version": 1,
+    "license": "CC-BY-SA-3.0",
+    "copyright": "sprites by sowelipililimute, inspired by sprites from /tg/station",
+    "size": {
+        "x": 32,
+        "y": 32
+    },
+    "states": [
+        {
+            "name": "minor"
+        },
+        {
+            "name": "severe"
+        },
+        {
+            "name": "critical"
+        }
+    ]
+}
diff --git a/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/minor.png b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/minor.png
new file mode 100644
index 0000000000..ed54499219
Binary files /dev/null and b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/minor.png differ
diff --git a/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/severe.png b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/severe.png
new file mode 100644
index 0000000000..877fed81e1
Binary files /dev/null and b/Resources/Textures/_Offbrand/Alerts/lung_damage.rsi/severe.png differ