IMPAIRED VENTILATORY RESPONSE TO CARBON-DIOXIDE IN PATIENTS WITH CHRONIC-RENAL-FAILURE - IMPLICATIONS FOR THE INTENSIVE-CARE UNIT

Objectives: To compare aspects of ventilatory control and the suscepti bility to depressant drugs between patients with chronic renal failure and normal volunteers. Design: Prospective, controlled study. Setting : Pulmonary function laboratory of a university hospital. Patients: Si x patients with chronic renal failure requiring hemodialysis and ten n ormal, control subjects. Interventions: Ventilatory responses to breat hing CO2 were studied using a rebreathing method The effects of triazo lam (0.5 mg orally) and meperidine (1 mg/kg, subcutaneously) on these measurements were also studied. Measurements and Main Results: Dialysi s patients showed definite impairment in the ventilatory response to C O2, which could not be accounted for by differences in respiratory mec hanics, muscle strength, or acid-base status. Meperidine impaired vent ilatory responses in control subjects and in renal patients, while tri azolam had little effect on either group. The effect of the drugs was not proportionately greater in dialysis patients than in control subje cts. Conclusions: Chronic renal failure results in a poorly responsive ventilatory control system, which may make renal failure patients mor e difficult to wean from mechanical ventilation. Theoretically, these patients may be more vulnerable to disturbances in blood gas homeostas is and subsequent respiratory arrest than other patients in an unmonit ored environment.