Because an elevated PaCO2 increases ventilatory drive in normal subjects, the clinical presence of hypercapnia indicates which of the following?
1. Inability of the stimulus to get to the muscles
2. Weak or missing central nervous system response to the elevated PCO2
3. Pulmonary muscle fatigue
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 3 only
d. 1, 2, and 3
ANS: D
Because an elevated PaCO2 increases ventilatory drive in healthy subjects, the very existence of hypoventilation suggests other problems with the respiratory apparatus. Specifically, the presence of acute respiratory acidosis indicates one of three major problems: (1) the respiratory center is not responding normally to the elevated PaCO2, (2) the respiratory center is responding normally, but the signal is not getting through to the respiratory muscles, or (3) despite normal neurologic response mechanisms, the lungs and chest bellows are simply incapable of providing adequate ventilation due to parenchymal lung disease or muscular weakness.
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