Calculations Commonly Used

in Respiratory Care

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

2 Calculations Commonly Used in Respiratory Care

1. Adjusting supplemental oxygen (FIO 2) for a 3. Airway resistance (spontaneous breathing)

desired PaO 2
desired PaO 2 × current FIO 2 Airway resistance (RaW) is the pressure difference devel-
Desired FIO 2 = oped per unit of flow.
current PaO 2
atmospheric pressure − alveolar pressure
EXAMPLE RaW =
flow
Your patient has a PaO2 level of 55 mm Hg on 30% oxygen.
The clinical goal is a PaO2 level of 90 mm Hg. What oxygen If possible, flow should be standardized at 0.5 L/sec
percentage should the patient have? (500 mL/sec). The answer will be in units of cm H2O/L/sec.

desired PaO 2 × current FIO 2 4. Airway resistance (mechanical ventilation)

Desired FIO 2 =
current PaO 2

90 mm Hg × 0.3 peak airway pressure − plateau pressure

Desired FIO 2 = RaW =
55 mm Hg flow in L sec
27 Calculate the flow in liters per second by taking the flow
Desired FIO 2 =
55 in liters per minute and dividing it by 60 seconds.
Desired FIO 2 = 0.49 or 49% oxygen
EXAMPLE
2. Air flow (total) through entrainment A mechanically ventilated patient has a peak airway pres-
mask sure of 30 cm water and plateau pressure of 20 cm water.
The peak flow is set at 60 L/min. Calculate peak flow in
EXAMPLE 1 liters per second:
1. Your patient has on a 28% air entrainment mask with 60 L min
an oxygen flow of 4 L/min. His condition worsens, and he = 1 L sec
60 sec
increases his minute volume to 15 L/min. To ensure that
he still receives his prescribed oxygen percentage, someone Calculate airway resistance:
makes a recommendation to you to increase the oxygen peak airway pressure − plateau pressure
liter flow to 6 L/min. The new total flow through the RaW =
flow in L sec
mask can be calculated as follows:
A 28% air entrainment mask has an air-to-oxygen ratio of 30 cm H 2O − 20 cm H 2O
Ra W = = 10 cm H 2O L sec
10 : 1. 1 L sec
• The sum of the ratio parts is 10 + 1 = 11.
• Total flow = 11 × 6 L/min oxygen flow = 66 L/min. 5. Alveolar ventilation
• This flow is more than four times the patient’s current Alveolar ventilation (VA) is the amount of tidal volume
minute volume. He should have all of his flow needs that reaches the alveoli. It is calculated by subtracting the
met. physiologic dead space (anatomic plus alveolar dead
• Reanalyze the delivered oxygen percentage to make space) from the measured exhaled tidal volume. For a
certain that it is as prescribed. bedside test, it is possible to subtract only the estimated
EXAMPLE 2 anatomic dead space. It is estimated at 1 mL/lb or 2.2 mL/
kg of ideal body weight.
Your patient is wearing a 40% air entrainment mask that
has the manufacturer’s suggested 8 L/min of oxygen
running into it. Her peak inspiratory flow is about 48 L/ EXAMPLE
min (0.75 L/sec). To what should her oxygen flow be A 154-lb/70-kg person has a measured tidal volume of
changed to ensure that the total gas flow is greater than 500 mL and an estimated anatomic dead space of about
her peak inspiratory flow? The new oxygen flow to the 154 mL.
mask can be calculated as follows:
• 40% air entrainment mask has an air-to-oxygen ratio of Calculated alveolar ventilation = 500 mL − 154 mL = 346 mL
3 : 1.
• The sum of the ratio parts is 3 + 1 = 4.
• Divide the sum of the ratio parts into the peak inspira- 6. Alveolar minute ventilation
.
tory flow: 48/4 = 12 Minute alveolar ventilation (VA) is the volume of gas
• Increase the oxygen flow from 8 to 12 L/min. that reaches the alveoli in 1 minute. It is found by multi-

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

 Calculations Commonly Used in Respiratory Care 3

plying the alveolar volume by the respiratory rate in 1 • 0.003 = oxygen-carrying capacity of blood plasma per
minute. torr PO 2
EXAMPLE CvO2 = ( Hb × 1.34 × SvO2 ) + (P vO2 × 0.003)
= (15 × 1.34 × 0.75) + ( 40 × 0.003)
A 154-lb/70-kg person has a measured tidal volume of = (15.1) + (0.1)
500 mL and an estimated anatomic dead space of about = 15.2 vol %
154 mL. The respiratory rate is 14/minute.
10. C(a − v̄)O2 difference
Calculated alveolar ventilation = 346 mL (500 mL − 154 mL)
Calculated minute alveolar ventilation = The C(a - v̄) O2 difference is the difference between the
14 × 346 mL = 4844 mL content of oxygen in arterial blood and the content of
oxygen in mixed venous blood.
7. Body surface area (BSA) (predicted) C(a − v̄)O 2 = CaO 2 − Cv̄ O 2

1 + weight in kilograms + (height in centimeters − 160) EXAMPLE

BSA =
100
Your patient has the following clinical data:
• CaO 2 = 19.8 vol % (See previous calculation.)
8. CaO 2 • Cv̄ O2 = 15.2 vol % (See previous calculation.)
CaO2 = The content of oxygen in arterial blood = vol % of
oxygen in arterial blood (vol % means mL of oxygen/100 mL C (a-v ) O2 difference = (CaO2 of 19.8 vol % ) − (Cv O2 of 15.2 vol % )
of blood).
= 4.6 vol %
CaO 2 = ( Hb × 1.34 × SaO 2 ) + ( PaO2 × 0.003)
11. Cardiac index (CI)
EXAMPLE cardiac output (CO)
CI =
Your patient has the following clinical data: body surface area ( BSA )
• PaO 2 = 95 torr
• SaO2 = 97% or 0.97 EXAMPLE
• 15 g/dL = The patient’s hemoglobin concentration A 166-lb/75-kg, 5′10″/152-cm man has a cardiac output
• 1.34 = mL of oxygen/g Hb in the patient (The value of of 6 L/min. According to the DuBois Body Surface Chart,
1.39 mL of oxygen/g Hb is occasionally used.) he has a BSA of 1.92 m2. His cardiac index is calculated as:
• 0.003 = The oxygen-carrying capacity of blood plasma
CO 6 L min
per torr PO 2 CI = = = 3.125 L min m2
BSA 1.92 m2

CaO 2 = ( Hb × 1.34 × SaO 2 ) + ( PaO2 × 0.003)

12. Cardiac output (CO) (predicted)
= (15 × 1.34 × 0.97 ) + (95 × 0.003)
= (19.5) + (0.3) BSA ×125
= 19.8 vol % CO =
0.045

9. Cv̄O 2 BSA = body surface area

Cv̄ O2 = The content of oxygen in venous blood = vol % of Using the Fick method:
oxygen in venous blood (vol % is mL of oxygen/100 mL of CO (mL min )
blood) oxygen consumption (mL min )
=
CvO 2 = ( Hb × 1.34 × SvO 2 ) + (P vO 2 × 0.003) arterial O2 content ( vol % ) − venous O2 content ( vol % )
In which:
EXAMPLE
vol % = volume percent or mL of oxygen 100 mL of blood
Your patient has the following clinical data:
• Pv̄ O2 = 40 torr Oxygen consumption = 250 mL min
• Sv̄ O 2 = 75% or 0.75 Arterial oxygen content = 20 vol %
• 15 g/dL = patient’s hemoglobin concentration
Mixed venous oxygen content = 15 vol %
• 1.34 = mL of oxygen/g Hb in the patient (The value of
1.39 mL of oxygen/g Hb is occasionally used.) C (a– v ) O2 = 5 vol %

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

4 Calculations Commonly Used in Respiratory Care

Therefore: of 15 L/min. Determine the total flow through the system.

250 mL min 250 mL min 250
Determine the ratio of oxygen to air.
CO = = =
20 vol % − 15 vol % 5 vol % 0.05 ( L min air × FIO2 of air) +
= 5000 mL min = 5 L min (L min O2 × FIO2 pure O2 ) = total flow × unknown FIO2
(15 × 0.21) + (10 × 1.0) = (15 + 10) × unknown FIO2
13. Cylinder duration (3.15) + (10) = (25) × unknown FIO2
13.15 = 25 FIO2
Minutes of flow ( ÷ by 60 to calculate hours) = (Divide both sides by 25.)
gauge pressure in psig × cylinder factor
liter flow 0.526 or 52.6% = FIO 2
Total flow = 15 + 10 = 25 L min
EXAMPLES
10 L min oxygen
1. Calculate the duration of flow of an E cylinder with Ratio =
15 L min air
1500 pounds per square inch gauge (psig) that is
running at 6 L/min.
15. Diffusing capacity (predicted DLCO SB)
Minutes of flow
1500 psig × 0.28
( divide by 60 to = The following equations can be used to calculate a pre-
calculate hours) 6L
dicted single breath lung diffusing capacity (DLCO SB) in
420 mL CO/min/mm Hg STPD (Gaensler and Wright, 1966):
=
6
Males: [(0.250 × height in inches ) − (0.177 × age in years)]
Minutes of flow = 70 (1.16 hr , or 1 hr and 10 min ) + 19.93

2. Calculate the duration of flow of an H cylinder with Females: [(0.284 × height in inches ) − (0.177 × age in years)]
1950 psig that is running at 9 L/min. + 7.72

Minutes of flow 16. Dynamic compliance

1950 psig × 3.14
(divide by 60 to =
calculate hours) 9L exhaled tidal volume − compressed volume
Cdyn =
6123 peak pressure − PEEP
=
9
in which compressed volume is the compliance factor ×
Minutes of flow = 680.33 (11.34 hr , or 11 hr and 20 min ) peak pressure.

14. Determining the flow of air and oxygen EXAMPLE

for a desired oxygen percentage (FIO2) Calculate the static and dynamic compliance on a venti-
through a “bleed-in” IMV or CPAP lated patient without PEEP therapy.
system Patient values:
Formula 1: • Exhaled tidal volume = 600 mL.
• Peak pressure = 30 cm water.
(L min air × FIO2 of air ) + (L min O2 × FIO2 pure O2 ) = • Static or plateau pressure = 20 cm water.
total flow × unknown FIO 2
• Compliance factor = 4 mL/cm water.
Formula 2: • Compressed volume at the plateau pressure = 80 mL
(4 mL/cm compliance factor × 20 cm).
F1C1 + F2C2 = F T C T
• Compressed volume at the peak pressure = 120 mL
in which F1 is the flow of first gas (oxygen), C1 is the con- (4 mL/cm compliance factor × 30 cm).
centration of oxygen in the first gas (1.0 for pure oxygen), 600 mL − 80 mL
F2 is the flow of second gas (air), C2 is the concentration Cst =
20 cm − 0
of oxygen in the second gas (0.21 for air), F T is the total 520 mL
=
fl ow of both gases, and C T is the concentration of oxygen 20 cm
in the mix of both gases. Use algebraic manipulation to = 26 mL cm water
solve for the unknown.
600 mL − 120 mL
Cdyn =
EXAMPLE 30 cm − 0
480 mL
Determine the oxygen percentage through a bleed-in =
30 cm
system that has an oxygen flow of 10 L/min and an airflow = 16 mL cm water

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

 Calculations Commonly Used in Respiratory Care 5

EXAMPLE In which:
T. I = 0.75 seconds
Calculate the static and dynamic compliance on a venti- V = 5.5 L/min. This is converted to mL/sec by dividing the
lated patient with PEEP therapy. flow in L/min by 60 seconds. So 5.5 L/min = 0.092 L/sec or
Patient values: 92 mL/sec.
• Exhaled tidal volume = 600 mL. Vc = 0.4 + 1.6 mL/cm water = 2 mL/cm water = 2 mL/cm water
• Because of refractory hypoxemia, 10 cm of PEEP × 15 cm water PIP = 30 mL
therapy is started.
Therefore:
• Peak pressure = 36 cm water.
• Static or plateau pressure = 25 cm water. Calculated tidal volume = (0.75 sec × 92 mL sec ) − 30 mL
• Compliance factor = 4 mL/cm water. = (69 mL ) − 30 mL
• Compressed volume at the plateau pressure = 60 mL = 39 mL ( This is within the ideal
[4 mL/cm compliance factor × 15 cm (25 cm − 10 cm tidal volume range of 30
PEEP)]. to 40 mL [based on 5 kg
weight × 6 to 8 mL kg ].)
• Compressed volume at the peak pressure = 104 mL
[4 mL/cm compliance factor × 26 cm (36 cm − 10 cm
PEEP)]. 18. FEV (timed)-to-FVC ratio
600 mL − 60 mL Predicted values for normal patients are as follows:
Cst =
25 cm − 10 cm • FEV0.5 = 50% to 60% of the FVC
=
540 mL • FEV1 = 75% to 85% of the FVC
15 cm • FEV2 = 94% of the FVC
= 36 mL cm water • FEV3 = 97% of the FVC
600 mL − 104 mL
Cdyn = 19. Forced expiratory flow (predicted) in the
36 cm − 10 cm middle of the FVC
496 mL
=
26 cm The predicted FEF25%-75% can be calculated in liters per
= 19 mL cm water second from the following equations (Morris, Koski, and
Johnson, 1971):
17. Estimated tidal volume during time- Men: [(0.047 × height in inches ) − (0.045 × age in years)]
triggered, pressure-limited, time-cycled + 2.513 (SD 1.12)
mechanical ventilation (TPTV)
Women: [(0.060 × height in inches ) − (0.030 × age in years)]
If the neonatal patient receiving TPTV is apneic and + 0.551 (SD 0.80)
neither assisting nor fighting against the ventilator-
delivered breath, it is possible to calculate an approximate
tidal volume. This is referred to as volume-oriented 20. Forced expiratory volume in 1 second
ventilation by some authors. The following formula is (predicted)
used: The predicted FEV1 in liters can be calculated from
Calculated tidal volume = ( TI × V ) − Vc the following equations (Morris, Koski, and Johnson,
1971):
In which:
T. I = inspiratory time Men: [(0.092 × height in inches ) − (0.032 × age in years)]
V = inspiratory flow rate on the ventilator in mL/sec − 1.260 (SD 0.55)
Vc = volume compressed in the circuit and ventilator Women: [(0.089 × height in inches ) − (0.024 × age in years)]
− 1.93 (SD 0.47 )
EXAMPLE
Estimate the delivered tidal volume for an apneic 5-kg
infant. The ventilator parameters are as follows: inspiratory 21. Forced vital capacity (predicted)
flow of 5.5 L/min, frequency of 20/min, I : E ratio of 1 : 3, The following are the predicted white patient normal values
inspiratory time of 0.75 seconds, and expiratory time of in liters for the FVC (Morris, Koski, and Johnson, 1971):
2.25 seconds. Peak inspiratory pressure (PIP) is 15 cm water.
The internal compliance of the ventilator is 0.4 mL/cm Men: [(0.148 × height in inches ) − (0.025 × age)] − 4.24 [SD 0.58]
water, and the circuit compliance factor is 1.6 mL/cm water.
Women: [(0.115 × height in inches ) − (0.024 × age)]
Calculated tidal volume = (TI × V ) − Vc − 2.85 (SD 0.52)

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

6 Calculations Commonly Used in Respiratory Care

− 20% saturation of COHb

EXAMPLE
80%
Calculate the predicted FVC of a 50-year-old white man − 1.5% saturation of MetHb
who is 6 feet (72 inches) tall. 78.5% saturation of arterial blood (SaO 2 of 78.5% )
FVC = [(0.148 × height in inches ) − (0.025 × age)] − 4.24
= [(0.148 × 72) − (0.025 × 50)] − 4.24
= (10.656 − 1.25) − 4.24
= 9.406 − 4.24 23. Functional residual capacity (predicted)
= 5.166 L
The following equations can be used for predicting
It is known that a black, Hispanic, and Asian person will
the normal FRC in liters (Bates, Macklem, and Christie,
have a smaller FVC than a white person of the same height.
1971):
Either use a prediction equation for the patient’s ethnic
background or make the following adjustment if the Males = (0.130 × height in inches ) − 5.16
above equation is used: (1) reduce the predicted FVC for Females = (0.119 × height in inches ) − 4.85
a black patient by 10% to 15%; (2) reduce the predicted
FVC for an Asian patient by 20% to 25%. There is less
certainty about the adjustment for a Hispanic patient.
24. Heart rate (HR) (target) for endurance
22. Functional hemoglobin and saturation training
values Target heart rate (HR ) = (% intensity [maximum HR
− resting HR ]) + resting HR
EXAMPLE
Target HR = the target HR for the exercise period
For a patient with normal COHb and MetHb levels: % intensity = 60% to 80%
Functional hemoglobin:
15.0 g total Hb
− 0.225 g COHb
= 14.775 g
− 0.15 g MetHb EXAMPLE
= 14.625 g functional Hb Determine the target HR for a 50-year-old patient (of
either gender) who is enrolled in an endurance training
Oxygen saturation: program. The patient has a resting HR of 80 beats/min.
The patient’s maximum heart rate is 170 (220 − 50 for the
100% potential saturation of O2 Hb in arterial blood patient’s age = 170).
− 1.5% saturation of COHb
98.5% Target HR = (% intensity [ maximum HR − resting HR ])
− 1.5% saturation MetHb + resting HR
97% saturation of arterial blood (SaO2 of 97% ) Lowest target HR = (0.60 [170 − 80]) + 80
= (0.60 [90]) + 80
= ( 54) + 80
EXAMPLE
= 134 beats min
For a patient with an elevated COHb and a normal MetHb level:
Highest target HR = (0.80 [170 − 80]) + 80
Functional hemoglobin:
= (0.80 [90]) + 80
15.0 g total Hb = (72) + 80
− 3.0 g COHb = 152 beats min
2.0 g
− 0.15 g MetHb
11.85 g functional Hb 25. Heart rate (maximum)
Either of the following may be used:
Oxygen saturation: a. Maximum HR = 220 − age of the patient
100% potential saturation of O2 Hb in arterial blood b. Maximum HR = 210 − (age of the patient × 0.65)

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

 Calculations Commonly Used in Respiratory Care 7

26. Heliox flow EXAMPLE

The heliox factor must be used to determine the
actual flow of heliox through an oxygen flowmeter, as 10 L min heliox desired
follows: 1.4
= 7.1 L min set on the oxygen flowmeter
Helium-to-oxygen Ratio Heliox Factor
1. 80% helium/20% oxygen 1.8 27. Inspiratory/expiratory (I : E) ratio
2. 70% helium/30% oxygen 1.6
Where TI is inspiratory time and TE is expiratory time.
3. 60% helium/40% oxygen 1.4
EXAMPLES
Calculating the heliox flow from an observed flow through an
oxygen flowmeter: 1. Calculate the patient’s TI and TE when the I : E ratio is
1. When using an 80% helium and 20% oxygen mix, 1 : 2 and f is 12/min.
multiply the observed flow by the heliox factor of 60 sec min
a. = 5 sec respiratory cycle
1.8. 12 breaths min
5 sec respiratory cycle
EXAMPLE b. = 1.66 sec for 1 part
3 parts of I and E
Observed oxygen flow of 10 L/min × 1.8 = 18 L/min actual c. TI = 1 part = 1.66 sec
heliox flow. d. TE = 2 parts = 3.32 sec
2. When using a 70% helium and 30% oxygen mix, mul- 2. Calculate the neonatal patient’s I : E ratio when the TI
tiply the observed flow by the heliox factor of 1.6. is 0.3 sec and the TE is 0.9 sec.
a. I : E = I/E = 0.3 sec/0.9 sec
EXAMPLE b. I/E = 1/3 (The I : E ratio is 1 : 3.)
Observed oxygen flow of 10 L/min × 1.6 = 16 L/min actual
heliox flow. 28. Maximum expiratory pressure (predicted)
3. When using a 60% helium and 40% oxygen mix,
multiply the observed flow by the heliox factor of
MEP prediction formulas (Black and Hyatt, 1969) are for
1.4.
spontaneously breathing, nonintubated adult subjects
EXAMPLE between 20 and 86 years old who are breathing from TLC.
Observed oxygen flow of 10 L/min × 1.4 = 14 L/min actual Age and Predicted Maximum
heliox flow. Expiratory Force Lower Limits of Normal
Males: 268 − (1.03 × age) +140 cm H2O
Calculating an oxygen flowmeter setting to deliver a needed flow
Females: 170 − (0.53 × age) +95 cm H2O
of heliox:
1. When using an 80% helium and 20% oxygen mix,
29. Maximum inspiratory pressure (predicted)
determine the observed flowmeter setting to deliver
an actual heliox flow of 10 L/min.
MIP prediction formulas (Black and Hyatt, 1969) are for
EXAMPLE spontaneous breathing, in nonintubated adult subjects
between 20 and 86 years old who are breathing from resid-
10 L min heliox desired ual volume.
1.8
= 5.6 L min set on the oxygen flowmeter Age and Predicted Negative
Inspiratory Force Lower Limits of Normal
2. When using a 70% helium and 30% oxygen mix, Males: 143 − (0.55 × age) = −75 cm H2O
determine the observed flowmeter setting to deliver Females: 104 − (0.51 × age) = −50 cm H2O
an actual heliox flow of 10 L/min.
30. Maximum voluntary ventilation
EXAMPLE (predicted)
10 L min heliox desired
The following equations can be used for predicting
the MVV in liters per minute (Cherniack and Raber,
1.6
= 6.3 L min set on the oxygen flowmeter 1972):
3. When using a 60% helium and 40% oxygen mix,
Males: [(3.03 × height in inches) − (0.816 × age in years)] − 37.9
determine the observed flowmeter setting to deliver
an actual heliox flow of 10 L/min. Females: [(2.14 × height in inches) − [0.685 × age in years)] − 4.87

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

8 Calculations Commonly Used in Respiratory Care

31. Mechanical dead space decimal fraction or ([ VT − VDanat ] − VDmech ) × f × PaCO2 =

percentage ([ VT − VDanat ] − VDmech ′ ) × f × PaCO2 ′
Using the original Bohr formula: In which:
( PaCO 2 − PECO 2 ) VT = current tidal volume
VD V T (or VD) =
PaCO 2
VDanat = anatomic dead space. This is calculated at 1 mL lb or
In which: 2.2 mL kg of ideal body weight.
VD V T or VD = the patient’s physiologic dead space VDmech = current mechanical dead space
PaCO 2 = the patient’s arterial carbon dioxide pressure f = ventilator rate

PECO 2 = the patient’s average exhaled carbon dioxide pressure PaCO2 = actual patient PaCO2 value

VDmech ′ = desired mechanical dead space

EXAMPLE (BASED ON NORMAL ADULT) PaCO2 ′ = desired patient PaCO 2 value
PaCO 2 = 45 torr
EXAMPLE
PECO 2 = 18 torr
Your patient is a 70-kg (154-lb) man who is being ventilated
(45 − 18) on the control mode (he is apneic). His ventilator settings
VD =
45 are tidal volume of 1000 mL, rate of 12/min, FIO2 of 0.3, no
27 added mechanical dead space. His ABGs are PaO2 of 90 torr,
= = 0 .6
45 PaCO2 of 30 torr, pH of 7.48, SaO2 of 95% and BE of 0. The
clinical goal is to adjust the patient’s mechanical dead space
The patient’s VD fraction can be recorded as 0.6 or 60%.
as needed to produce a PaCO2 of 40 torr. In summary:
VT = 1000 mL current tidal volume
32. Mechanical dead space volume
Using the original Bohr formula: VDanat = 154 mL anatomic dead space. This is calculated
at 1 mL lb or 2.2 mL kg of ideal body weight.
( PaCO 2 − PECO 2 )
VD V T (or VD) = = VT VDmech = no added mechanical dead space
PaCO 2

In which: f = 12 for ventilator rate

VD V T or VD = the patient’s physiologic dead space PaCO2 = 30 torr actual patient PaCO2 value

V T = the average exhaled tidal volume VDmech′ = the desired amount of mechanical dead space

PaCO 2 = the patient’s arterial carbon dioxide pressure PaCO2 ′ = 40 torr desired patient PaCO2 value
PECO 2 = the patient’s average exhaled carbon dioxide pressure Placing the data and goal into the formula results in the
following equation:
EXAMPLE (BASED ON NORMAL ADULT) ([ VT − VDanat ] − VDmech ) × f × PaCO 2 =
[[ VT − VDanat ] − VDmech ′ ] × f × PaCO 2 ′
V T = 500 mL
([1000 − 154 ] − 0) × 12 × 30 = ([1000 − 154 ] − VDmech ′ ) × 12 × 40
PaCO 2 = 40 torr
Simplifying produces the following equation:
PECO 2 = 28 torr
(846) × 12 × 30 = (846 − VDmech ′ ) × 480
( 40 − 28) 12
VD = = × 500 = 0.3 × 500 mL = 150 mL
40 40 304,560 = (846 × 480) − ( VDmech ′ × 480)
The patient’s physiologic VD volume = 150 mL. 304,560 = 406,080 − 480 VDmech ′

−101,520 = −480 VDmech ′

33. Mechanical dead space for a desired
PaCO 2 211.5 mL = VDmech ′
It can be used to calculate how much dead space to add The solution is to increase the patient’s mechanical dead
or subtract. space from 0 to 212 mL.

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

 Calculations Commonly Used in Respiratory Care 9

34. Medication calculations 1 mL or 1 g of active ingredient in 200 mL or 200 g of the

The problems are easier to solve by remembering the solution. This converts to 1000 mg/200 mL. Set up the
following: following proportion:
• One milliliter (1 mL) or 1 cubic centimeter (1 cc) of 1000 mg active ingredient
water = 1 gram (g) of mass. =
200 mL total solution
• Most drug doses are listed in milligrams instead of 2.5 mg (cross multiply )
grams. Convert grams to milligrams by moving the
x mL solution
decimal point three places to the right (the same as
multiplying by 1000). For example, 0.5 g equals 500 mg. 1000 x = 500 mL (Divide both sides of the equation by 1000.)
• Know how to interconvert fractions, decimal fractions,
x = 0.5 mL of Proventil that should be given
.
and percentages. For example, 1 : 100 = 1/100 = 0.01 =
1%.
Amount of Active Ingredient
EXAMPLE
EXAMPLES How much 4% Xylocaine would be needed to give a patient
How much active ingredient would be in 0.5 mL of 100 mg of active ingredient by handheld nebulizer before
adrenaline? a bronchoscopy?
A 1% (1 : 100) drug concentration means that there is 1 A 4% drug concentration means that 4 parts of active
part of active ingredient in 100 parts of the solution, or ingredient are in 100 parts of the solution, or 4 mL or 4 g
1 mL or 1 g of active ingredient in 100 mL or 100 g of the of active ingredient in 100 mL or 100 g of the solution.
solution. This can be set up in the following proportion: This converts to 4000 mg/100 mL. Set up the following
proportion:
1 mL active ingredient
= 4000 mg active ingredient
100 mL total solution =
100 mL total solution
unknown active ingredient or x
(cross multiply ) 100 mg (cross multiply )
0.5 mL solution
x mL solution
100 x = 0.5 mL (Divide both sides of the equation by 100.)
4000 x = 10, 000 mL (Divide both sides of the equation by 4000)
.
x = 0.005 mL = 0.005 g = 5 mg of active ingredient
x = 2.5 mL of Xylocaine should be given.

EXAMPLE 35. Minute volume for a desired PaCO 2

How much active ingredient would be in 0.25 mL of
Alupent? (Alupent is 5.0% active ingredient.) The patient is a 70-kg (154-lb) man who is being venti-
A 5% drug concentration means that there are 5 parts of lated on the control mode (he is apneic). His ventilator
active ingredient in 100 parts of the solution, or 5 mL or settings are:
5 g of active ingredient in 100 mL or 100 g of the solution. • Tidal volume = 1000 mL, rate 12 times/min.
This can be set up in the following proportion: • FIO 2 = 0.3; no added mechanical dead space
5 mL active ingredient • PaO 2 = 90 torr
= • PaCO 2 = 30 torr
100 mL total solution
• pH = 7.48
unknown active ingredient or x
(cross multiply ) • SaO2 = 95%
0.25 mL solution
• BE = 0 .
100 x = 1.25 mL (Divide both sides of the equation by 100.) Determine the new minute volume ( VE′) needed to produce
a PaCO 2 value of 40 torr.
x = 0.0125 mL = 0.0125 g = 12.5 mg of active ingredient
current PaCO 2 × current V E
V E ′ =
desired PaCO 2
Volume of Medication Solution
30 × 12, 000
EXAMPLE V E ′ =
40
How much 0.5% Proventil would be needed to give a
360, 000
patient 2.5 mg of active ingredient by SVN? V E ′ =
A 0.5% (1 : 200) drug concentration means that there is 1 40
part of active ingredient in 200 parts of the solution, or V E ′ = 9000 mL

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

10 Calculations Commonly Used in Respiratory Care
36. Normal lung/thoracic compliance
Normal lung compliance (CL) in an adult is 0.2 L/cm
water. The normal adult’s thoracic compliance (CT)
has been determined to be 0.2 L/cm water. However,
because the lungs tend to collapse smaller and the thorax
cage tends to expand out, the two opposing forces offset
each other somewhat. Because of this, the lung/thoracic
compliance (CLT) is calculated as 0.1 L (or 100 mL)/cm
water.
37. PAO 2
The formula presented here is the most commonly used
of several versions:
PaCO2
PAO 2 = [(P B − PH 2 O) FIO2 ] −
0 .8
• PAO2 = pressure of alveolar oxygen.
• P B = barometric pressure of air. This is 760 torr
(mm Hg) at sea level; it decreases as the altitude
increases.
• PH2O = pressure of water vapor in the lungs. This is
47 torr (mm Hg) at the normal temperature of
98.6° F/37° C. Remember that water vapor pressure
increases if the patient has a fever and decreases if the
patient is hypothermic.
• FIO2 = fractional concentration (percentage) of inspired
oxygen. Use whatever percentage of oxygen your patient
is breathing in.
PaCO2
= effect of carbon dioxide and the patient’s metabolism.
0.8
The factor of 0.8 is based on how much oxygen a normal
person uses in 1 minute and how much carbon dioxide is
produced in 1 minute.
38. P(A-a)O2
EXAMPLE 1
You are working in a major teaching hospital in Miami.
The patient’s physician asks you to calculate the P(A -a)O2
on a 30-year-old patient. The following conditions exist:
• PB = 760 torr
• PH2O = 47 torr because your patient’s temperature
is 98.6° F/37° C
• FIO2 = 0.21 because the patient is breathing room air
• PaCO2 = 40 torr from ABGs
• PaO2 = 90 torr from ABGs
• R = 0.8
1. PAO2 = ([PB − PH2O] FIO2) − PaCO2/0.8
2. PAO2 = ([760 − 47] 0.21) − 40/0.8
3. PAO2 = ([713] 0.21) − 50
4. PAO2 = (150) − 50
5. PAO2 = 100 torr
6. P(A -a)O 2 = 100 − 90 = 10 torr
Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Interpretation: AP(A-a)O2 of 10 torr is normal for a patient
of this age. It is normal to see a difference between the alveo-
lar and arterial oxygen levels that starts in the range of 4 to
12 torr and slowly increases with age.
EXAMPLE 2
You are working in a major teaching hospital in Denver.
You are asked to calculate the alveolar-arterial difference
in oxygen on a 40-year-old patient. The following condi-
tions exist:
• PB = 710 torr
• PH2O = 50 torr because your patient’s temperature
is 100° F/38° C
• FIO2 = 0.35 because the patient is breathing 35%
oxygen by mask
• PaCO2 = 55 torr from ABGs
• PaO2 = 65 torr from ABGs
• R = 0.85
1. PAO2 = ([PB − PH2O]FIO2) − PaCO2/0.8
2. PAO2 = ([710 − 50] 0.35) − 55/0.85
3. PAO2 = ([660] 0.35) − 65
4. PAO2 = (231) − 65
5. PAO2 = 166 torr
6. P(A -a)O 2 = 166 − 65 = 101 torr
Interpretation: The difference of 101 torr is elevated,
even though this patient is older than the patient in
Example 1.
39. PCO 2 (predicted) value in a blood gas
analyzer
The predicted PCO2 value at a given CO2 percentage is
calculated with this formula:
PCO2 = (PB − PH 2 O) × % CO2
In which PCO2 is the predicted PCO2 in torr, PB is the
barometric pressure at the institution where the
analysis is being performed, P H2O is the water vapor pres-
sure based on the patient’s temperature, 47 torr at
37° C/98.6° F, and % CO2 is the percentage of CO2 (also
listed as FCO2).
EXAMPLE
Example for one-point (balance) potentiometer calibra-
tion at sea level in which PCO2 is the predicted PCO2 in torr,
PB is 760 torr, PH2O is 47 torr, and % CO2 is 5%.
1. PCO2 = (760 − 47) × 0.05
2. = (713) × 0.05
3. = 35.65 or 36 torr
Therefore set the PCO2 control at 36 torr.
40. PO2 (predicted) value in a blood gas
analyzer
The predicted PO2 value at a given O2 percentage is calcu-
lated with this formula:
 Calculations Commonly Used in Respiratory Care 11

PO2 = (P B − PH 2 O) × % O2 45. Respiratory exchange ratio or respiratory

In which PO2 is the predicted PO2 in torr, PB is the baro- quotient
metric pressure at the institution where the analysis is Where:
being performed, PH2O is the water vapor pressure based R = respiratory exchange ratio
on the patient’s temperature, 47 torr at 37° C/98.6° F, RQ
. = respiratory quotient
and % O2 is the percentage of O2 (also listed as FO 2). V. CO2 = production of carbon dioxide in 1 minute
VO2 = consumption of oxygen in 1 minute

EXAMPLE The following calculation is based on a normal person’s

metabolism:
PO2 is the predicted PO2 in torr, PB is 760 torr, PH2O is
V CO2 200 mL min
47 torr, and % O2 is 12%: R or RQ = = = 0 .8
V O2 250 mL min
1. PO2 = (760 − 47) × 0.12
2. = (713) × 0.12 If possible, use actual patient values for carbon dioxide
3. = 85.56 or 86 torr production and oxygen consumption.
Therefore set the PO2 control at 86 torr.
46. Respiratory rate for a desired PaCO 2
41. Peak flow (predicted)
The same formula that was used to predict a tidal volume
The predicted peak flow (PF) in liters (Cherniack and
change can be used to help predict what respiratory rate will
Raber, 1972) per second:
produce a desired PaCO2 value:
Men :[(0.144 × height in inches) − (0.024 × age )] + 2.225
( VT − [ VDanat + VDmech ]) × f × PaCO2 =
Women : [(0.090 × height in inches) − (0.018 × age )] + 1.130 ( VT − [ VDanat + VDmech ]) × f ′ × PaCO2 ′
The PF is directly related to height and indirectly related
to age. Therefore, the taller the patient, the greater the PF. EXAMPLE
The PF decreases with age. The patient is the same 70-kg (154-lb) man who is being
ventilated on the control mode (he is apneic). His ventila-
42. Peak flow improvement tor settings are a tidal volume of 1000 mL, rate of 12
times/min, FIO2 of 0.3, and no added mechanical dead
The percentage of improvement in PF (after inhaling a
space. His ABG values are an arterial oxygen pressure
bronchodilator medication) is calculated by using this
(PaO2) of 90 torr, PaCO2 of 30 torr, pH of 7.48, SaO2 of
formula:
95%, and a base excess (BE) of 0. The clinical goal is to
Percentage of change = adjust the patient’s rate as needed to produce a PaCO2
after drug airflow − before drug airflow value of 40 torr. In summary:
×100 V T = 1000 mL current tidal volume
before drug airflow
VDanat = 154 mL of anatomic dead space (This is calcu-
43. Pulmonary vascular resistance (PVR) lated at 1 mL/lb or 2.2 mL/kg of ideal body weight.)
VDmech = no added mechanical dead space
f = 12 times/min for the ventilator rate
The patient must have mean pulmonary artery pressure
f ′ = desired ventilator rate
(PAm), pulmonary capillary wedge pressure (PCWP), and
PaCO2 = 30 torr, actual patient PaCO2 value
cardiac output (CO) measured and placed into this
PaCO2′ = 40 torr, desired patient PaCO2 value
formula:
Placing the data and goal into the formula results in the
mean pulmonary artery pressure (PAm ) − following:
pulmonary capillary wedge pressure (PCWP )
PVR = × 80 ( VT − [ VDanat + VDmech ]) × f × PaCO2 =
cardiac output (CO)
( VT − [ VDanat + VDmech ]) × f ′ × PaCO 2 ′
The answer will be in units of dynes·sec·cm−5. (1000 − [154 + 0]) × 12 × 30 = (1000 − [154 + 0]) × f ′ × 40

44. Residual volume value (predicted) [846] × 12 × 30 = [846] × f ′ × 40

The following equations can be used for predicting the 304 , 560 = 33, 840 f ′
normal RV in liters (Goldman and Becklake,1959):
9=f′
Males: [(0.069 × height in inches ) + (0.017 × age in years)] − 3.45
The solution is to reduce the patient’s respiratory rate
Females: [(0.081 × height in inches ) + (0.009 × age in years)] − 3.90 from 12 to 9 breaths/min.

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

12 Calculations Commonly Used in Respiratory Care

47. Shunt percentage S Q

T= P ( A − a ) O2 × 0. 003
Q
Modifi ed Clinical Shunt Equation C (a − v ) O 2 + [P ( A − a ) O 2 × 0.003]
(663 − 155) × 0.003
s Q
t= P ( A − a ) O2 × 0.003 =
Q (20.6 − 15.2) + [(663 − 155) × 0.003]
C (a − v ) O2 + [P ( A − a ) O2 × 0.003]
(508) × 0.003
=
In which: 5.4 + [(508) × 0.003]
1.5
PAO2 = the partial pressure of oxygen in the alveoli calculated =
from the alveolar oxygen equation 5.4 + 1.5
1.5
PaO2 = the partial pressure of oxygen in the arterial blood =
6.9
0.003 = the oxygen-carrying capacity of blood plasma per mm = 0.217 or 21.7% shunt
Hg PO 2
C(a − v)O2 = the oxygen content of arterial blood minus the Classic Shunt Equation
oxygen content of mixed venous blood
 T = CcO 2 − CaO2
S Q
Q
Modified Clinical Shunt Equation Example CcO 2 − CvO 2
Patient information:
• PB = Local barometric pressure; 760 torr for sea level in In which:
this example CcO2 = content of oxygen in the end
• PH2O = 47 torr; water vapor pressure in the lungs at pulmonary capillary blood
normal body temperature
CaO 2 = content of oxygen in the arterial blood
• FIO2 = inhaled oxygen percent of 100% or 1.0
• PaO2 = 155 torr CvO 2 = content of oxygen in the mixed venous blood
• PaCO 2 = 40 torr
• SaO2 = 100% or 1.0 Classic Shunt Equation Example
• Pv̄ O 2 = 40 torr Patient information:
• Sv̄ O2 = 75% or 0.75 • PB = local barometric pressure; 760 torr for sea level in
• 0.8 = the normal respiratory quotient (An exact value this example
can be determined by a metabolic study.) • PH 2O = 47 torr; water vapor pressure in the lungs at
• 15 g/dL = the patient’s hemoglobin concentration normal body temperature
• 0.003 = the oxygen-carrying capacity of blood plasma • FIO 2 = inhaled oxygen percent of 30% or 0.3
per torr PO2 • PaO2 = 95 torr
• 1.34 = mL of oxygen/g Hb in the patient (The value of • PaCO 2 = 40 torr
1.39 mL of oxygen/g Hb is occasionally used.) • SaO2 = 97% or 0.97
Preliminary calculations: • Pv̄ O2 = 40 torr
1. Oxygen content of arterial blood: • Sv̄ O2 = 75% or 0.75
• 0.8 = normal respiratory quotient (An exact value can
CaO 2 = ( Hb × 1.34 × SaO2 ) + (PaO2 × 0.003 ) be determined by a metabolic study.)
= (15 × 1.34 × 1.0) + (155 × 0.003) • 15 g/dL = patient’s hemoglobin concentration
= (20.1) + (0.5) • 0.003 = oxygen-carrying capacity of blood plasma
= 20.6 vol %
per torr PO2
2. Oxygen content of mixed venous blood: • 1.34 = mL of oxygen/g Hb in the patient (The value of
1.39 mL of oxygen/g Hb is occasionally used.)
CvO2 = (Hb × 1.34 × SvO 2 ) + (PvO 2 × 0.003)
= (15 × 1.34 × .75) + (40 × 0.003)
Preliminary calculations:
= (15.1) + (.1) 1. Oxygen content of arterial blood:
= 15.2 vol % CaO 2 = ( Hb × 1.34 × SaO2 ) + (PaO2 × 0.003 )
3. Partial pressure of oxygen in the alveoli: = (15 × 1.34 × 0.97 ) + (95 × 0.003)
= (19.5) + (0.3)
PaCO 2 = 19.8 vol %
PAO 2 = [(PB − PH 2O) × FIO2 ] −
0.8
40 2. Oxygen content of mixed venous blood:
= [(760 − 47 ) × 1.0] −
0.8
= [713] − 50 CvO2 = (Hb × 1.34 × SvO 2 ) + (PvO 2 × 0.003)
= 663 torr = (15 × 1.34 × 0.75) + (40 × 0.003)
= (15.1) + (0.1)
Final calculation: = 15.2 vol %

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

 Calculations Commonly Used in Respiratory Care 13

3. Partial pressure of oxygen in the alveoli: 51. Tidal volume

.
PaCO2 An average VT is found by dividing the minute volume (VE)
PAO2 = [(PB − PH2 O) × FIO2 ] − by the respiratory rate (f). If this cannot be done, find the
0 .8
40 average volume of at least six breaths. The average, pre-
= 760 − 47 × 0.3 −
[ ( ) ]
0 .8 dicted tidal volume for a resting, afebrile, alert adult
= [ 214 ] − 50 should be about
= 164 torr
3 to 4 mL lb of ideal body weight or
4. Oxygen content of pulmonary capillary blood: 7 to 9 mL kg of ideal body weight
CcO 2 = (Hb × 1.34 × ScO 2 ) + (PAO 2 × 0.003)
= (15 × 1.34 × 1.0) + (164 × 0.003)
EXAMPLE
= 20.1 + 0.492
= 20.1 + 0.5 (rounded off to one decimal place ) The predicted tidal volume range of a 154-lb (70-kg)
= 20.6 vol % patient is calculated as follows:

Final calculation: 3 to 4 mL lb × 154 lb = 462 to 616 mL

7 to 9 mL kg × 70 kg = 490 to 630 mL
 T = CcO 2 − CaO2
S Q
Q
CcO 2 − CvO 2
20.6 − 19.8 52. Tidal volume for a desired PaCO 2
=
20.6 − 15.2
0.8 The following formula can be used to help predict what
= tidal volume produces a desired PaCO2 value:
5 .4
= 0.15 or 15% shunt ( VT − [ VDanat + VDmech ]) × f × PaCO2 =
( VT′ − [ VDanat + VDmech ]) × f × PaCO2 ′
48. Static compliance
in which
exhaled tidal volume − compressed volume • VT = current tidal volume
Cst =
plateau pressure − PEEP • VDanat = anatomic dead space (This is calculated at
1 mL/lb or 2.2 mL/kg of ideal body weight.)
in which compressed volume is the compliance factor × • VDmech = added mechanical dead space
plateau pressure. • f = respiratory (ventilator) rate
49. Stroke volume (SV) • PaCO2 = actual patient PaCO2 value
• VT′ = desired tidal volume
cardiac output (CO) • PaCO2′ = desired patient PaCO2 value
SV =
heart rate (HR ) Note that other, simpler formulas are available for calcu-
lating a change in minute volume or tidal volume. This
one is presented because it takes into account more factors
EXAMPLE and can be used to calculate a change in tidal volume, rate,
or mechanical dead space.
Heart rate = 100 beats/min

Cardiac output = 8 liters (8000 mL)

EXAMPLE
The patient is a 70-kg (154-lb) man who is being venti-
CO 8000 mL
SV = = = 80 mL lated on the control mode (he is apneic). His ventilator
HR 100
settings are a tidal volume of 1000 mL, rate of 12 times/
min, fractional inspired oxygen concentration (FIO2) of
50. Systemic vascular resistance (SVR) 0.3, and no added mechanical dead space. His ABG values
The patient must have mean arterial pressure (MAP), are an arterial oxygen pressure (PaO2) of 90 torr, PaCO2 of
central venous pressure (CVP), and cardiac output (CO) 30 torr, pH of 7.48, SaO2 of 95%, and base excess (BE) of
measured and placed into this formula: 0. The clinical goal is to adjust the patient’s tidal volume
as needed to produce a PaCO2 value of 40 torr. In summary:
mean arterial pressure ( MAP ) −
• VT = 1000 mL current tidal volume
central venous pressure (CVP )
SVR = × 80 • VDanat = 154 mL of anatomic dead space (This is calcu-
cardiac output (CO)
lated at 1 mL/lb or 2.2 mL/kg of ideal body weight.)
The answer will be in units of dynes·sec·cm−5. • VDmech = no added mechanical dead space

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

14 Calculations Commonly Used in Respiratory Care

• f = 12 times/min for the ventilator rate Calculating expiratory time [tE (E)]
• PaCO2 = 30 torr actual patient PaCO2 value
tE = 60/f − tI
• VT′ = desired tidal volume
• PaCO2′ = 40 torr desired patient PaCO2 value Calculating inspiratory-to-expiratory ratio (I : E or tI/tE)
Placing the data and goal into the formula results in the
I : E = tI tE, usually numerator
following:
Calculating percentage inspiratory time (%tI)
( VT − [ VDanat + VDmech ]) × f × PaCO2 =
( VT′ − [ VDanat + VDmech ]) × f × PaCO2 ′ %tI = tI tI + tE ×100
(1000 − [154 + 0]) × 12 × 30 = ( VT′ − [154 + 0]) × 12 × 40
54. Total lung capacity
Simplifying produces the following:
TLC is most commonly calculated by adding the FRC to
(846) × 12 × 30 = ( VT′ − 154 ) × 480 the IC found through spirometry. Be prepared to add or
subtract various combinations of volumes and capacities
304 , 560 = 480 VT′ − 73, 920
to find the TLC. See Figure 1 for an example:
378, 480 = 480 VT′
TLC = VT + IRV + ERV + RV
788 mL = VT′
The solution is to reduce the patient’s tidal volume from 55. Ventilator tubing compliance factor
1000 to 788 mL.
The compliance factor is found by dividing the exhaled
53. Time variable in mechanical ventilation tidal volume by the pressure.

Calculating frequency (rate)(f): EXAMPLE

The pressure is found to be 80 cm water and the measured
Count breaths min or 60 tI + tE
tidal volume is found to be 320 mL.
Calculating cycle time (tI + tE): 320 mL
Compliance factor = = 4 mL cm water
Add tI + tE or 60 f 80 cm

Calculating inspiratory time [ tI (I)]:

tI = 60 f − tE or tI = %tI × (tI + tE )

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.

 Calculations Commonly Used in Respiratory Care 15

Figure 1 Lung volumes and capacities for a clinically normal young man.
(From Sills JR: The Comprehensive Respiratory Therapist Exam Review, ed 6, St Louis, 2016, Mosby.)

Copyright © 2016 by Saunders, an imprint of Elsevier Inc. All rights reserved.