Respiratory CO2 response depends on plasma bicarbonate concentration in mechanically ventilated patients

Abstract

Objective: There is controversy about the effects of high plasma bicarbonate concentration ([HCO3(-)]) and the CO2 response test. We analyzed the relationship between [HCO3(-)] and the variation in hydrogen ion concentration (pH) for a given change in PaCO2, and its effects upon CO2 response.

Design: A retrospective study was carried out.

Setting: Two intensive care units.

Patients: Subjects with and without chronic obstructive pulmonary disease (COPD), at the beginning of weaning from mechanical ventilation.

Interventions: The CO2 response was evaluated by the re-inhalation of expired air method, measuring the hypercapnic ventilatory response (ΔVE/ΔPaCO2) and hypercapnic drive response (ΔP01/ΔPaCO2), where VE is minute volume and P0.1 is airway occlusion pressure 0.1s after the initiation of inspiration.

Main outcome measures: [HCO3(-)] and CO2 response.

Results: A total of 120 patients in the non-COPD group and 48 in the COPD group were studied. COPD patients had higher mean [HCO3(-)] than non-COPD patients (33.2 ± 5.4 vs. 25.7 ± 3.7 mmol/l, p<0.001). In both non-COPD and COPD patients we observed a significant inverse linear relationship between [HCO3(-)] and pH change per mmHg of PaCO2 (p<0.001), ΔVE/ΔPaCO2 (p<0.001) and ΔP0.1/ΔPaCO2 (p<0.001).

Conclusions: There is an inverse linear relationship between [HCO3(-)] and the variation of pH for a given change in PaCO2 and the CO2 response.

Keywords: Bicarbonate; Bicarbonato; Centro respiratorio; Chronic obstructive pulmonary disease; Enfermedad pulmonar obstructiva crónica; Hipercapnia; Hypercapnia; Mechanical ventilation; Respiratory center; Ventilación mecánica.