Oxygen Delivery

Muhammad Husni Thamrin

SMF Anestesi dan Terapi Intensif
RS DR Moewardi
• The single-cell organism (e.g. amoeba) requires oxygen
for its survival and obtains it from the environment
from simple diffusion. This relies upon Fick’s first law of
diffusion:

• O2 diffusion = K x A/T x ∆P1

• K= konstanta gas
• A= luasnya permukaan membran
• T= tebalnya membran
• ∆P= perbedaan tekanan parsial antar membran
 OXYGEN DELIVERY
Transport of oxygen to the cells can thus be divided into
six simple steps reliant only on the laws of physics:
1. convection of oxygen from the environment into the
body (ventilation)
2. diffusion of oxygen into the blood (oxygen uptake)
3. reversible chemical bonding with haemoglobin
4. convective transport of oxygen to the tissues (cardiac
output: CO)
5. diffusion into the cells and organelles
6. the redox state of the cell
 STEP 1: CONVECTION – VENTILATION
• The first step occurs in the lung in the form of
pulmonary ventilation.
• At sea level the partial pressure of oxygen in
environmental air is approximately 160 mmHg
• at the alveolus the PaO2 is 100 mmHg.
• Much of oxygentherapy is based on increasing
oxygen delivery into thelungs, whether it be
by masks or other devices
 STEP 2: DIFFUSION – ALVEOLUS TO
BLOOD
• Oxygen within the alveolus diffuses across the
alveolar–capillary membrane.
• The average thickness of the alveolar capillary
membrane is 0.3 mm and the surface area of
the respiratory membrane is 50–100 m2.
• This leads to a PaO2 in the pulmonary
capillaries of approximately 90 mmHg.
 STEP 2 cont’d
• the problems seen in the critically ill where two
mechanisms predominate:
• 1. the thickness and barrier effect of the space
between alveolus and capillary
• 2. the relationship between perfusion and
ventilation at alveolar level (V/Q ratio)

• Good ventilation and good perfusion is ideal

while poorventilation and poor perfusion is bad
 STEP 3: HAEMOGLOBIN BINDING
• Oxygen is poorly soluble in water, having a
solubility of 0.003 082 g/100 g H2O.
• Having diffused across the alveolar capillary
membrane, the oxygen binds rapidly to the
respiratory pigment haemoglobin
 STEP 4: CONVECTION –
CARDIOVASCULAR
• Convection of oxygen by the cardiovascular
system is influenced mainly centrally by CO
and peripherally by local controls of the
regional perfusion of the tissues.
• The delivery of oxygen also relies on the
concentrationof oxygen in the blood (CaO2).
This is calculated by thefollowing formula:
• Cao2 = ([Hb](g/dl)x 1.34 x Sao2) +
(0.003xPao2)