The Ventilatory Recruitment Threshold for Carbon Dioxide

We report our initial experience with a technique with which the chemoresponsiveness of the respiratory controller can be characterized in terms of an inspiratory on-switch threshold to CO2. After suppression of phasic respiratory muscle activity by mechanical ventilation, a CO2 recruitment threshold (PCO2RT) was defined as the lowest alveolar CO2 tension at which CO2 supplementation to inspired gas caused a reappearance of inspiratory efforts. Because PCO2RT can be determined in the absence of a mechanical load on the ventilatory pump, respiratory system mechanics and inspiratory muscle function should not influence the measurement itself. Thus, this technique may be helpful to study ventilatory requirements and load responses in critically ill patients with respiratory failure. We have shown that inspiratory muscle recruitment can be equally well-inferred from changes in the airway pressure and flow tracings during mechanical ventilation, from the pattern of chest wall displacement, and from the integrated diaphragm electromyogram. Within a subject, PCO2RT is a reproducible measurement that is not influenced by ventilator settings and end-expiratory lung volume, provided that phasic respiratory muscle has been suppressed prior to CO2 supplementation. Details of the methodology, the likely determinants of PCO2RT, and the clinical utility of this technique are discussed.