Self-control and external control of mechanical ventilation give equal air hunger relief

Elevated end-tidal partial pressure of CO2 (PETCO2) causes air hunger; this sensation becomes intense with a relatively small rise in PETCO2 if ventilation is held constant. Spontaneously breathing subjects increase ventilation in response to CO2 thereby greatly diminishing air hunger. In healthy subjects and ventilator-dependent patients, experimenter-induced increases in ventilator tidal volume (VT) relieve air hunger even if PETCO2 is kept elevated. We addressed two questions: (1) Can paralyzed, ventilator-dependent patients use the sensation of air hunger to effectively control ventilator VT using nonrespiratory motor pathways; and (2) Do subjects obtain more relief when in control of their own ventilator? Four subjects were trained to increase ventilator Vr using a mouth-operated switch. Subjects' ratings of air hunger intensity in response to elevated PETCO2 were compared during three conditions: (1) constant VT; (2) subject-controlled VT; and (3) experimenter-controlled VT. When given control of their ventilator, all subjects increased VT in response to increased PETCO2, thereby relieving air hunger. Air hunger relief was similar when the experimenter mimicked these VT changes. These results suggest that: (1) ventilator-dependent patients can use sensation, conscious decisions, and nonrespiratory motor pathways to achieve an appropriate respiratory response to increased P-CO2 and (2) control of one's own ventilation is unimportant in these circumstances.