01/09/2021

Basic physiology and

Oxygen therapy
Ahmed Mukhtar M.D

1 Function of respiratory system

2 What are the types of respiratory failure

Objectives
3 What are the types of oxygen therapy

Respiratory function

Co2 out O2 in

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Respiratory function

Co2 out O2 in
• Alveolar ventilation • Alveolar O2
pressure (PAO2)
• Ventilation-
perfusion matching • Ventilation-
perfusion matching

O2 in

• Alveolar O2 pressure (PAO2)

• Ventilation-perfusion matching

Alveolar oxygen pressure

(PAO2)

Oxygen

Carbon
dioxide

Water
vapour

Nitrogen

Alveolar pressure=PAO2+PACO2+PAH2O+PAN2

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Alveolar oxygen pressure

(PAO2)

O2 O2 O2
O2
O2 O2
O2
O2 O2
O2 O2 O2

Alveolar oxygen pressure

(PAO2)
Room air
PaO2=90 mmHg

PAO2
100 mmHg
O2
O2 O2
O2 O2 O2

Alveolar pressure

O2 therapy Oxygen

Carbon
dioxide
Water
vapour
Nitrogen

Alveolar pressure= PAO2+PACO2+PAH2O+PAN2

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Alveolar oxygen pressure

(PAO2)
O2 50%
PaO2=250 mmHg

PAO2
300 mmHg
O2
O2 O2
O2 O2 O2

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O2 in

• Alveolar O2 pressure (PAO2)

• Ventilation-perfusion matching

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Ventilation-perfusion

O2

O2 O2 O2
O2 Hb
Hb
O2
O2 O2 O2 200
O2
ml OO22
200 ml O2 O2 Hb O2
Hb
O2
O2

O2 O2 O2 Hb
O2 O2

1 liter of air V̇ Q̇ 1 liter of blood

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Ventilation-perfusion

O2

O2 O2 O2
O2 Hb
Hb
O2
O2 O2 O2 200
O2
ml OO22
200 ml O2 O2 Hb O2
Hb
O2
O2

O2 O2 O2
Hb
O2 O2

1 liter of air V̇ : 1Q̇ 1 liter of blood

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Ventilation-perfusion

O2 O2 O2
O2
O2
O2 O2 O2
O2
O2 O2
O2 O2 O2

V̇ : Q̇ 1

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Ventilation-perfusion
Hypoxemia

O2 O2
O2

V̇ : Q̇ 0.5

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Co2 out

• Alveolar ventilation

• Ventilation perfusion matching

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Dead space

150 ml

Part of the lung that doesn’t

participate in gas exchange

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Alveolar ventilation

Tidal Minute
Patient A volume
RR
volume

200 40 8 liters

Tidal Minute
Patient B volume
RR
volume

400 20 8 liters

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Alveolar ventilation

Tidal Minut
Patient A volume
RR
volume
200- 40 2 liters
150

Tidal Minut
Patient B volume
RR
volume

400- 20 5 liters
150

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Illustrative case

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Illustrative case I
• 70-year-old male patient, with history of angina presented to ER
with dyspnea.
• Initial assessment at ER
• Blood pressure is 120/70 mmHg,
• PaO2 is 70 mmHg on room air,
• Respiratory rate 35 breaths per minute,

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Illustrative case I

1 Is the patient hypoxemic or not?

2 Does the patient have respiratory

Failure or not?

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Is the patient hypoxemic or not?

What is meant by hypoxemia?

Hypoxemia referred to reduced PaO2 below normal value

PaO2/FiO2

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PaO2/FiO2 ratio
P/F

Expected P/F ratio Vs Observed P/F ratio

Observed PaO2 is
Expected P/F= 400-500
measured from ABG

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Room Air PaO2/FiO2 ratio

FiO2=21%
PaO2=70
P/F
PaCo2=30

Expected P/F ratio Vs Observed P/F ratio

Expected P/F =400-500 Observed PaO2 is 80

Observed P/F
70/0.21=330

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Illustrative case I

1 Is the patient hypoxemic or not?

Yes
2 Does the patient have respiratory
Failure or not?

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Acute respiratory failure

Type II Type I

• PaCO2 > 50 mmHg • PaO2< 60 mmHg

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Acute respiratory failure

V/Q mismatch Hypoventilation

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V/Q mismatch

O2 O2
O2

V̇ : Q̇ 0.5

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V/Q mismatch
Obstructive Interstitial lung Pulmonary edema
airway disease disease Alveolar collapse

OO O O OOOO O OOOO O
2O2
2O O O2 2O O O2
2 2
2O O O2
2 2
2 2 2 2 2
2 2 2 2 2 2 2

Airway Diffusion Excessive

obstruction impairment alveolar filling

In all these cases PAO2 (alveolar oxygen) is

greater than arterial oxygen tension

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Hypoventilation

Hypoventilation

Increase in Decrease in
PAO2
PaCO2 PAO2
O2 Decrease in
CO2 CO2 CO2 PaO2

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Illustrative case I

1 Is the patient hypoxemic or not?

Yes
2 Does the patient have respiratory
Failure or not? No

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How can we monitor oxygenation?

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Oxygen Delivery
• When the oxygen enters the
blood it first diffuse in the
plasma and then bind to
hemoglobin

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Oxygen Loading

• Partial pressure of oxygen in the

blood is termed PaO2

• Percent of oxygen bound to

hemoglobin in arterial blood is
termed SaO2

• When measured by pulse

oximetry SaO2 is termed SPO2

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Oxygen Loading
PaO2 decreased

Oxygen bound to
Hb decreased

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Oxygen Loading
PaO2 < 60 mmHg

SaO2 < 90%

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Pulse oximeter

• Measuring saturation

• Measure hear rate

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Limitation: Inaccurate reading

Low perfusion
Nail polish

Improper positioning Excess light

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How can we manage hypoxemia?

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Hypoxemia management

Oxygen Therapy Ventilation

Variable Fixed
Invasive Non-invasive
performance performance

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Hypoxemia management

Flow=30-60 L/min
It depends on effort of
patient

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Variable performance devices

Inspired oxygen will vary

by effort of the patient

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Variable performance devices

Nasal canula Open mask Non-rebreathing

mask

Flow must be at least 5 Inspired oxygen may

Maximum flow 6 l/min
l/min reach 90%

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Fixed performance devices

Inspired oxygen will not

vary by effort of the patient

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Fixed performance devices

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THANK YOU
Every life counts

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