Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits*

Permissive hypercapnia improves outcomes in patients with respiratory failure, most likely because of a reduction in ventilator-induced lung injury. Because hypercapnia is a potent vasoactive stimulus, adequate tissue perfusion and oxygen delivery to dilated microvessels may be restored. We examined how Paco2 affects microvascular changes, hemodynamics, and cardiac output in rabbits. We evaluated the permissive range of Paco2 required for maintenance of the peripheral circulation.Prospective experimental animal study.Animal research laboratory.A total of 31 Japanese domestic white rabbits.The animals were anesthetized with pentobarbital. An ear chamber was prepared to examine blood vessels by intravital microscopy. The rabbits were mechanically ventilated with air, oxygen, and CO2. The values of Paco2 were adjusted to about 20 (hypocapnia), 40 (normocapnia), 60, 80, 100, 125, 150, and >250 mm Hg (hypercapnia). After stabilization at each Paco2 level, microvascular changes were recorded with a microscope-closed video camera to permit analysis of arteriolar diameter and blood flow.The pH and heart rate decreased and mean blood pressure increased progressively as the Paco2 was increased. When Paco2 was increased from 20 to 80 mm Hg, vessel diameter, blood-flow velocity, and blood-flow rate increased markedly. Cardiac output increased slightly. When Paco2 exceeded 100 mm Hg, all of these variables decreased. When Paco2 exceeded 150 mm Hg, all variables were significantly lower than the control values (p < .01).Intravital microscopic visualization of the rabbit ear microcirculation showed that 150 mm Hg is the permissive upper limit of acute hypercapnia with respect to maintenance of the peripheral microcirculation.