Fraction of inspired oxygen

Fraction of inspired oxygen (FiO₂) is the fraction or percentage of oxygen in the space being measured. Medical patients experiencing difficulty breathing are provided with oxygen-enriched air, which means a higher-than-atmospheric FiO₂. Natural air includes 20.9% oxygen, which is equivalent to FiO₂ of 0.209. Oxygen-enriched air has a higher FiO₂ than 0.21, up to 1.00, which means 100% oxygen. FiO₂ is typically maintained below 0.5 even with mechanical ventilation, to avoid oxygen toxicity.^[1] If a patient is wearing a nasal cannula or a simple face mask, each additional liter of oxygen adds about 4% to their FiO2 (for example, a patient with a nasal cannula with 2L of oxygen attached would have an FIO2 of 21% + 8% =29%).

Often used in medicine the FiO₂ is used to represent the percentage of oxygen participating in gas-exchange. If the barometric pressure changes, the FiO₂ may remain constant while the partial pressure of oxygen changes with the change in barometric pressure.

Equations

Abbreviated alveolar air equation

$P_A O_2 = \frac{P_E O_2 - P_i O_2 \frac{V_D}{V_t}}{1- \frac{V_D}{V_t}}$

P_AO₂, P_EO₂, and P_iO₂ are the partial pressures of oxygen in alveolar, expired, and inspired gas, respectively, and VD/VT is the ratio of physiologic dead space over tidal volume.

Medicine

In medicine the FiO₂ is the assumed percentage of oxygen concentration participating in gas exchange in the alveoli.^[2]

Uses

The ratio between partial pressure of oxygen in arterial blood (PaO2) and FiO₂ is used as an indicator of hypoxemia per the American-European Consensus Conference on lung injury. A high FiO₂ has been shown to alter the ratio of PaO2/FiO₂.^[2]

PaO2/FiO2 ratio

The ratio of partial pressure arterial oxygen and fraction of inspired oxygen, sometimes called the Carrico index, is a comparison between the oxygen level in the blood and the oxygen concentration that is breathed. This helps to determine the degree of any problems with how the lungs transfer oxygen to the blood.^[3] A sample of arterial blood is collected for this test.^[4] A PaO2/FiO2 ratio less than or equal to 200 mmHg is necessary for the diagnosis of acute respiratory distress syndrome by the AECC criteria.^[5] The more recent Berlin criteria defines mild ARDS at a ratio of <300.

A PaO2/FiO2 ratio less than or equal to 250 mmHg is one of the minor criteria for severe community acquired pneumonia (i.e., possible indication for inpatient treatment).

A PaO2/FiO2 ratio less than or equal to 333 mmHg is one of the variables in the SMART-COP risk score for intensive respiratory or vasopressor support in community-acquired pneumonia.

Related mathematics

Alveolar air equation

The alveolar air equation is the following formula, used to calculate the partial pressure of alveolar gas:

$P_A O_2 = F_I O_2(PB-P H_2 O) - P_A CO_2 (F_I O_2 + \frac{1-FIO2}{R})$

See also

• Oxygen toxicity

References

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688103/
2. Allardet-Servent J, Forel JM, Roch A, Guervilly C, Chiche L, Castanier M, et al. (2009). "FIO2 and acute respiratory distress syndrome definition during lung protective ventilation.". Crit Care Med 37 (1): 202–7, e4–6. doi:10.1097/CCM.0b013e31819261db. PMID 19050631.
3. Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, et al. (2005). "Transfusion-related acute lung injury: definition and review.". Crit Care Med 33 (4): 721–6. doi:10.1097/01.ccm.0000159849.94750.51. PMID 15818095.
4. Tietz NW (Ed): Clinical Guide to Laboratory Tests, 3rd ed. W. B. Saunders, Philadelphia, PA, 1995.
5. Mason, R. Murray and Nadel's Textbook of Respiratory Medicine, 5th ed. Philadelphia, PA 2010

External links

• FiO2 by Delivery Device - Shows FiO2 by common oxygen deliver systems.