Вы находитесь на странице: 1из 45

PerfEd INTERNATIONAL

OXYGENATION PRINCIPLES
Michael S. Vinas, MA-HRM

Oxygen, the most abundant element on Earth

present on the Earth as gases (O2, O3, O4);


H2O, and in countless chemical formulas

Oxygen 1:4
Oxygen, symbol O, colorless, odorless,
tasteless, slightly magnetic gaseous
element. On earth, oxygen is more
abundant than any other element.
Oxygen was discovered in 1774 by the
British chemist Joseph Priestley and,
independently, by the Swedish chemist
Carl Wilhelm Scheele; it was shown to be
an elemental gas by the French chemist
Antoine Laurent Lavoisier in his classic
experiments on combustion.

Oxygen 2:4
Oxygen composes 21 percent by
volume or 23.15 percent by weight of
the atmosphere; 85.8 percent by weight
of the oceans (88.8 percent of pure
water is oxygen); and, as a constituent
of most rocks and minerals, 46.7
percent by weight of the solid crust of
the earth. Oxygen comprises 60 percent
of the human body. It is a constituent of
all living tissues; almost all plants and
animals, including all humans, require
oxygen, in the free or combined state,
to maintain life.

Oxygen 3:4
Three structural forms of oxygen are
known: ordinary oxygen, containing two
atoms per molecule, formula O2; ozone,
containing three atoms per molecule,
formula O3; and a pale blue,
nonmagnetic form, O4, containing four
atoms per molecule, which readily
breaks down into ordinary oxygen.
Three stable isotopes of oxygen are
known; oxygen-16 (atomic mass 16) is
the most abundant. It comprises 99.76
percent of ordinary oxygen and was
used in determination of atomic weights
until the 1960s.

Oxygen 4:4
Gaseous oxygen can be condensed to a
pale blue liquid that is strongly
magnetic. Pale blue solid oxygen is
produced by compressing the liquid.
The atomic weight of oxygen is
15.9994; at atmospheric pressure, the
element boils at -182.96 C (-297.33
F), melts at -218.4 C (-361.1 F), and
has a density of 1.429 g/liter at 0 C
(32 F).

AIR:OXYGEN RATIOs
AIR
0
1
2
3
4
5
6
7
8

OXYGEN
8
7
6
5
4
3
2
1
0

RATIOFIO2
0:8
1:7
1:3
1:1.67
1:1
1:0.60
1:0.33
1:0.142
8:0

1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.21

Normal production of Oxygen is through


the process of Photosynthesis, the
conversion of CO2 into O2.

Manufacturing of Oxygen
The process of mechanical processing of
Oxygen is a technique known as Fractional
Distillation.
Oxygen is compressed to its Critical
Pressure which converts O2 in the gaseous
state to its liquid state, a pale blue color
with a slight garlic smell.
Oxygen may be stored as a bulk liquid agent
in Thermos type containers or brought up
to just above its Critical Temperature and
stored in high pressure gas cylinders

Oxygen Storage; Gaseous and Liquid

Oxygen is measured as mm. Hg. or Torr. Given


a normal barometric pressure
of 760 mm. Hg. at sea level, zero
percent relative humidity, Oxygen
would exert a partial pressure of
159 Torr [(760) x (20.95/100)]

Normal atmospheric Oxygen, inspired, is heated to 37C @


100% relative hymidity. Relative humidity @ 37C, 100%
exerts a partial pressure of 47 Torr. Thus, the Oxygen tension is
reduced to 149 Torr, PCO2 of 40 reduces O2 tension further to
105 Torr. The diffusion across the Alveolar-Capillary
membrane presents a O2 of 100-104 Torr to the capillary blood.

Blood Gas Electrodes

Oxygen tension is measured by a Clark electrode that measures the


electric charge produced by the oxidative reduction of a chemical
agent when introduced to a sample containing Oxygen.
pH=Glass Electrode
PCO2=Severinghaus Electrode
PO2=Clark Electrode

The Oxyhemoglobin Dissociation Curve is sigmoid shaped


@ 37C, a normal pH, PCO2, 2,3 DPG levels. P50 denotes
the PaO2 @ 50% Saturation and identifies Hb affinity for
O2.

Of the cells only Erythrocytes contain


Hemoglobin, the element that transports Oxygen
as Oxyghemoglobin.
Each Gram is capable of carrying 1.34 ml of
combined Oxyhemoglobin, each mm Hg. Of PO2
is capable of carrying 0.0031 ml. Dissolved
Oxygen

Oxygen transport starts from the time of conception


through cellular metabolism then the umbilical cord/
Placenta until birth. The fetus blood contains Hemoglobin
F which has a higher hemoglobin and affinity for Oxygen
than adult Hemoglobin; Hb A.

The lungs resume the process of gas exchange at the AlveolarCapillary level after birth until death.

Premature delivery before 28 weeks results in


mechanical ventilation requirements

HEMOGLOBIN/ HEMATOCRIT
The hemoglobin in infant and pediatric patient's has been
surveyed and reported between the ranges of 12.5-22 gm./dL
(Hartley-Winkler). Hemodilutional calculations, however, are
predicated on hematocrit values.
AGE HEMOGLOBIN VALUES
1 Day 18-22 GM/DL
2 Weeks 17 GM/DL
3 Months 10 GM/DL
3-5 Years 12.5-13 GM/ DL

The Placenta exchanges Oxygen and Carbon


Dioxide, nutrients from the Mother to the
Fetus umbilicus until full term Gestation,
however, the lungs may be developed enough
after 28 weeks to forego artificial mechanical
ventilation

Oxygen is transported through the AlveolarCapillary membrane to the capillaries arterioles


arteries

The main objective is cellular oxygen


exchange; conversion of ADP to ATP

primarily at the Mitochondrial levels

Oxygen deprivation for 3-5 minutes may


lead to irreversible Brain death.

As important, Oxygen deprivation of


myohemoglobin may lead to irreversible
heart damage

Oxygen is a critical component of the Krebs, Citric Acid


Cycle in preventing lactic acidosis

Krebs Cycle; Aerobic Metabolism 2:3

Krebs Cycle 3:3

METABOLIC ACIDOSIS
The aerobic Krebs; Citric Acid cycle
is shut down and replaced by the
anerobic Embden-Meyerhoff cycle
which converts Pyruvic into Lactic
Acid. The increased hydrogen ions
affect the respiratory center of the
Medulla Oblongata affecting
increased ventilation. Venous blood
is presented to the AlveolarCapillary membrane, H + HCO3
associates into H2CO3-, Carbonic
Acid, then dissociates into water and
CO2 gas. The Renal Glomerulus
excretes excess H+.

METABOLIC ACID continued


Acidemia causes migration of K+
from the interstitum, affecting the
Nervous systems Na+ pump. The
combination produces Myocardial
depression, decreased CO,
hemostasis, microaggregate
formation, thrombus formation and
possible Myocardial Infarction (MI).
The Renal System attempts to
eliminate H+ via the tubular
Glomerulus.

EXTRACOROREAL MEMBRANE OXYGENATION is


the artificial exchange and delivery of Oxygen.
ECC=artificial oxygen transport

Bubbler Oxygenators
Have a direct gas to
blood interface, thus
causing contact and
complement pathway
activation leading to
activation of C3 and
C5A; pulmonary and
myocardial edema

Membrane Oxygenators eliminate direct gas to blood interfacing and


emulate the O2 and CO2 transfer rates of the lungs via microporus
polypropylene hollow fibers; Carmeda or Trillium bonded

Cardiovascular Perfusionist Calculations

To adequately determine oxygenation delivery


and consumption several formulas are
deployed Arterial Oxygen Content, CaO2 Vol.%

Venous Oxygen Content, CvO2 Vol.%


A-V Content Difference
Oxygen Delivery ml./ min.
Oxygen Extraction %
Oxygen Consumption
ml./ min.
ml./ Kg.
METS

Oxygen Delivery
CaO2=Arterial Oxygen Content Vol.%

Hb x 1.34 x (SaO2/100) + (PaO2 x 0.0031)


CvO2=Venous Oxygen Content Vol.%
Hb x 1.34 x (SvO2/100) + (PvO2 x 0.0031)
Ca-vO2=arterial/ venous Oxygen content
gradient Vol.%=5 Vol.%

Oxygen consumption is normally derived from the Fick


equation. This method calculates the arterial and venous
oxygen content difference and multiplies that value by the
cardiac output in L/M x 10 (Bolen, Miller).
VO2 (ml./min.) = (CaO2-CvO2) x CO x 10
During ECC, if the Hgb, C.O. and A/V venous saturations
are known, oxygen consumption may be calculated
without knowing the PO2 values since dissolved oxygen
normally contributes less than 0.3 Volumes %. of the
arterial O2 content.
VO2 (ml./min.) = Hb. x 1.34 x [(SaO2-SvO2)/100] x CO x
10
The basal oxygen consumption of a neonate may vary due
to a variety of factors. Extracorporeal flowrate
requirements are predicated on the predicted basal and
hypothermic oxygen requirements, level of anesthesia,
degree of hemodilution, oxygen carrying capacity, degree
of hypothermia etc.

Proper Assessment of Oxygen Requirements


The only proper method to assess Oxygen
consumption is via the Fick Equation.
Patients in the OR, intubated, chemically
paralyzed, artificially ventilated and slightly
hypothermic will have approximately 30%
metabolic reuirements than at a Steady State,
thus 250 ml./min Vol.% is reduced to 170 ml./
min.
7% additional reduction per degree Celsius
hypothermia

BASAL OXYGEN CONSUMPTION (VO2) vs. BODY WEIGHT


VO2 RANGE
ml./Kg./min
7.5-9.58
7.5-9.00
6.5-8.50
6.0-7.50
5.5-6.50
5.0-6.00
4.5-5.50
4.5-5.00
ADULT 4.0-5.00

AVERAGE

KG.

METS

5.05
8.25
7.50
6.75
6.00
5.50
5.00
4.75
3.50

05
10
15
20
25
30
35
40
70

2.43
2.36
2.00
1.93
1.71
1.57
1.43
1.36
1.00

VO2
ml./min.
42.5
82.5
112.5
135.0
150.0
165.0
175.0
190.0
250.0

Adopted from: Galletti, P.M. and Brecher, G.A.,


Heart- Lung Bypass: Principles and Techniques of Extracorporeal Circulation, Grune &
Stratton, New York; 1962.

CARDIOVASCULAR ECC PERFUSION


CALCULATIONS
BSA = Square Root [Ht. (Cm) x Wt. (kg)] / 3600
Blood Volume (BV); Females = Kg. x 55; Males= Kg. x 70
Hemodilutional Hct. = Blood Vol. x (Hct./100) / Blood Vol. + Prime Vol.

Extracorporeal Circulation Blood Flowrates:


37C = 100% x (BSA x CI), V/Q = 1.0 : 1.00 @ Alpha Stat
30C = 75% x
(BSA x CI), V/Q = 0.8 : 1.00 @ Alpha Stat
28C = 67% x (BSA
x CI), V/Q = 0.6 : 1.00 @ Alpha Stat
25C = 50% x (BSA x CI), V/Q = 0.5 : 1.00 @ Alpha
Stat
18C = 25% x (BSA x CI),

SUMMARY
ECC formulas are essential for proper application of ECC
Oxygenation
It is prudent to maintain normal acceptable clinical Hematology,
Electrolytes and Acid-Base balance for proper Oxygen Transport
Anemia, Acidosis, Electrolyte Imbalances will impair proper
Oxygenation processes

Okay folks, thats a wrap!