Arterial-expired PCO2 differences in the dog during acute hypercapnia

Chronic moderate hypercapnia suppresses ventilatory responses to acute CO<sub>2</sub> challenges

Chronic hypercapnia (CH) is a hallmark of chronic lung disease, and CH increases the risk for acute-on-chronic exacerbations leading to greater hypoxemia/hypercapnia and poor health outcomes. However, the role of hypercapnia per se (duration and severity) in determining an individual's ability to tolerate further hypercapnic exacerbations is unknown. Our primary objective herein was to test the hypothesis that mild-to-moderate CH (arterial [Formula: see text] ∼50-70 mmHg) increases susceptibility to pathophysiological responses to severe acute CO₂ challenges. Three groups (GR) of adult female goats were studied during 14 days of exposure to room air (<i>GR 1</i>; control) or 6% inspired CO₂ (<i>GR 2</i>; mild CH), or 7 days of 6% inspired CO₂ followed by 7 days of 8% inspired CO₂ (<i>GR 3</i>; moderate CH). Consistent with previous reports, there were no changes in physiological parameters in <i>GR 1</i> (RA control), but mild CH (<i>GR 2</i>) increased steady-state ventilation and transiently suppressed CO₂/[H⁺] chemosensitivity. Further increasing InCO₂ from 6% to 8% (<i>GR 3</i>) transiently increased ventilation and arterial [H⁺]. Similar to mild CH, moderate CH increased ventilation to levels greater than predicted. However, in contrast to mild CH, acute ventilatory chemosensitivity was suppressed throughout the duration of moderate CH, and the arterial - mixed expired CO₂ gradient became negative. These data suggest that moderate CH limits physiological responses to acute severe exacerbations and provide evidence of recruitment of extrapulmonary systems (i.e., gastric CO₂ elimination) during times of moderate-severe hypercapnia.<b>NEW &amp; NOTEWORTHY</b> Moderate levels of chronic hypercapnia (CH; ∼70 mmHg) in healthy adult female goats elicited similar steady-state physiological adaptations compared with mild CH (∼55 mmHg). However, unlike mild CH, moderate CH chronically suppressed acute CO₂/[H⁺] chemosensitivity and reversed the arterial to mixed expired CO₂ gradient. These findings suggest that moderate CH suppresses vital mechanisms of ventilatory control and recruits additional physiological systems (i.e., gastric CO₂ release) to help buffer excess CO₂.

Anesthetic properties of carbon dioxide in the rat

BACKGROUND

Carbon dioxide decreases halothane minimum alveolar concentrations (MAC) in dogs when Paco(2) exceeds 95 mm Hg. We sought to confirm these findings for several potent inhaled anesthetics in rats.

METHODS

Groups of eight rats were anesthetized with halothane, isoflurane, or desflurane. MAC was determined for each anesthetic alone, and then with increasing concentrations of inspired CO(2). A fourth group was given CO(2) alone to determine the MAC of CO(2).

RESULTS

Increasing inspired CO(2) concentrations produced a linear dose-dependent decrease in MAC of each potent inhaled anesthetic. With elimination of CO(2), the MAC of isoflurane and desflurane returned to the original MAC. As determined by extrapolating these data to 0% of the inhaled anesthetic, the MAC of CO(2) was approximately 50% of 1 atm. Given alone, CO(2) proved lethal.

CONCLUSIONS

Unlike dogs, no threshold for the CO(2)-MAC response arose with halothane, isoflurane, or desflurane in rats. The ED(50) for CO(2) is also approximately 50% greater in rats than reported in dogs.

Influence of sleep state on CO2 responsiveness. A study of the unloaded respiratory pump in humans

We measured the ventilatory recruitment threshold for CO2 (RT) during wakefulness, nonrapid eye movement sleep (NREM), and rapid eye movement sleep (REM) in eight patients with respiratory failure. Because the lungs were mechanically ventilated during the RT measurements, we were able to define the effects of arousal state on the chemoresponsiveness of the unloaded respiratory system. Ventilator settings were held constant in each patient, assuring that mechanoreceptor input to the respiratory controller remained the same during all measurements. RT increased from 38 +/- 6 mm Hg during relaxed wakefulness to 42 +/- 8 mm Hg during NREM sleep (p less than or equal to 0.01), consistent with a blunting of chemoresponsiveness during sleep. In five subjects we were able to measure RT during REM sleep also. In four of them, REM RT exceeded the wakefulness measurement by at least 3 mm Hg. The remaining patient showed no demonstrable changes in RT during either sleep state. We conclude that the loss of a wakefulness stimulus contributes to sleep-induced hypercarbia in humans.

Arterial-end tidal PCO2 equilibration in the cat during acute hypercapnia

We have studied the problem of pulmonary capillary-alveolar CO2 exchange in the cat during acute hypercapnia. Three cats, anesthetized with xylazine and pentobarbital sodium and prepared with acute tracheostomy and femoral arterial catheter, and three awake cats, prepared with a small tracheal catheter and femoral arterial catheter, were subjected to acute hypercapnia (FICO2 = 0.00, 0.06, and 0.08). During steady states, end tidal PCO2 was determined with an infrared analyzer, and arterial PCO2 was measured with a Radiometer ABL-2 analyzer in simultaneously drawn samples. In vitro studies indicated that our blood sampling techniques resulted in a 6% reduction in PCO2. Blood PCO2 readings were corrected for (1) non-ideal performance of the analyzer as determined by tonometry, (2) 6% reduction due to sampling, and (3) differences between electrode and rectal temperature. Mean arterial-end tidal PCO2 differences were not significantly different from zero in any condition in either group (except for 0.08 CO2 in the awake group when the difference was 2.0 Torr). These findings in the cat agree with the classical view that PCO2 in pulmonary capillary blood approaches PCO2 in alveolar gas. Further, our findings provide evidence that CO2 loss from blood samples is an important technical factor which can cause systematic underestimation of blood PCO2 and, hence, contribute to the observation of negative PCO2 gradients.

Simultaneous O2 and CO diffusing capacity estimates from assumed lognormal VA, Q and DL distributions

O2 and CO pulmonary transfer data obtained in dogs under steady-state conditions in hypoxia by Savoy et al. (Respir. Physiol. 42: 43-59, 1980) have been submitted to reevaluation and have yielded new estimates of the lung diffusing capacity, DL. For the proposed DL computation it has been assumed that functional inhomogeneity can be considered as resulting from lognormal distributions of the VA/Q and VA/DL ratios. The standard deviation, sigma, of the VA/Q distribution is computed from the measured (PA -Pa)CO2, and the same sigma value is assumed to prevail for the VA/DL distributions. This is equivalent to assume constant DL/Q ratios in the entire lung. With the so defined distributions, DL values, called D sigma O2 and D sigma CO, were sought, for which the model calculations yielded O2 partial pressures and CO fluxes equal to those measured. Compared with DL estimates computed with conventional procedures, these results show that D sigma O2 is twice as large as DLO2 computed with ideal alveolar PO2 and that D sigma CO lies between DLCO computed with the mean alveolar PCO and that computed with the ideal alveolar PCO. The D sigma O2/D sigma CO ratio was on the average 1.2, a value which, unlike the ratios obtained with conventional DLO2 and DLCO estimates, is in good agreement with the characteristics of diffusion and of chemical association of O2 and CO with blood.

Comparison of steady state pulmonary diffusing capacity estimates for O2 and CO in dogs

In view of the fact that the inhomogeneity effects on pulmonary diffusing capacity (DL) estimates are quite different for O2 and for CO, simultaneous determinations of steady-state DLCO and DLO2 were attempted and compared. To this end, pulmonary gas exchange was measured in 17 anesthetized and artificially ventilated dogs, in hypoxia with and without carbon monoxide in inspired gas (FIO2 = 0.12, FICO = 0.0009 to 0.0016). The diffusing capacity estimates were computed by two conventional procedures, the first (Dapp) taking into account the mean alveolar partial pressures and the second (DVDA) the ideal alveolar partial pressures. It was found that the presence of COHb in blood, inevitable in the steady-state DLCO procedure, leads to a marked underestimation of DLO2; therefore DLCO values could only be adequately compared to DLO2 values obtained in the absence of CO from inspired gas. These DLO2 were 18.5 and 33.4 mumol . min-1 . Torr-1 . kg-1 for the mean DappO2 and DVDAO2, respectively, whereas the DLCO values obtained after 15 to 25 min CO inspiration were 30.0 and 83.4 mumol . min-1 . Torr-1 . kg-1 for the mean DappCO and the mean DVDACO, respectively. The salient feature is that with both procedures the mean value of DLCO estimate is higher than the corresponding DLO2 estimate. This finding suggests that in anesthetized, artificially ventilated dogs DappO2 and DVDACO estimates obtained by steady-state procedures in hypoxia are largely influenced by inhomogeneity effects and of limited value for assessment of the diffusing properties of the lung. DappCO and DVDAO2 are also affected by inhomogeneities but to a lesser degree.

Blood/gas equilibrium of carbon dioxide in lungs. A critical review

(1) The scope of this review is to examine the experimental evidence for the existence of negative PCO2 differences between pulmonary capillary blood and lung gas, [delta PCO2(b-G)], which have been observed both during rebreathing, when CO2 was at equilibrium, and during steady state gas exchange, particularly in hypercapnia. (2) The mechanism that have been invoked to explain negative delta PCO2(b-G) include (i) slow equilibration of the system CO2/HCO3-/H+ in blood, and (ii) effects of a negatvely charged surface of the pulmonary capillary endothelium. While the first postulated mechanism appears to be quantitatively insufficient to explain the results, the second seems to lead to serious qualitative difficulties. (3) Existence of negative delta PCO2(b-G) in CO2 equilibrium would invalidate the basis of the conventional analysis of alveolar gas exchange. (4) A critical analysis of the experimental evidence for the existence of negative delta PCO2(b-G) is presented. It includes the identification of directional experimental errors leading to spurious negative delta PCO2(b-G), and a critical review of the literature data in this regard. (5) Results of own experiments, conducted in an attempt to consider all possible sources of error, are reported, revealing (i) perfect PCO2 equality between alveolar gas and blood in rebreathing equilibrium of CO2; (ii) absence of negative delta PCO2 (b-G) during steady state gas exchange in hypercapnia. (6)Both experiments and model calculations show that negative delta PCO2 between mixed venous blood and end-expired gas observed in birds at steady state of gas exchange are explained by a particular action of the Haldane effect in avian parabronchial lungs with cross-current arrangement of gas and blood flow. (7) It is concluded that the negative delta PCO2(b-G) reported in the literature are probably artifactual and that there is no adequate evidence to invalidate the traditional view according to which blood/gas CO2 equilibration in lungs leads to equal PCO2 in both media.