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Oxygen partial pressure – pO2
Reference interval pO2 – examples
Physiological significance of pO2
Why measure pO2 ?
When should pO2 be measured ?
Causes of hypoxemia
Symptoms associated with hypoxemia
Causes of hyperoxemia
The amount of oxygen in blood is controlled by many variables, e.g. ventilation/perfusion. pO2 is the partial pressure of oxygen in a gas phase in equilibrium with the blood. pO2 only reflects a small fraction (1 – 2 %) of total oxygen in blood that is dissolved in blood plasma . The remaining 98 – 99 % of oxygen present in blood is bound to the hemoglobin in the erythrocytes.
pO2 primarily reflects the oxygen uptake in the lungs.
Reference interval pO2 – examples
pO2(a) decreases at the rate of ~0.29 kPa (2.2 mmHg) per decade after the age of 40 .
Physiological significance of pO2
Life depends on the continuous supply of oxygen to tissue cells, which in turn depends on the continuous oxygenation of venous blood in the lungs. Oxygen diffuses down a pressure gradient from a relatively high level (21.2 kPa (159 mmHg) at sea level) in inspired air, to progressively lower levels in the respiratory tract, the alveolar gas, the arterial blood, capillaries and finally the cell/mitochondria, where the lowest pO2 level (1 – 1.5 kPa (7.5 – 11.5 mmHg)) is observed. This decrease in pO2 from inspired air to the mitochondria is called the oxygen cascade (Fig. 3). The pressure gradient of the oxygen cascade is physiologically essential for the delivery of inspired oxygen to tissues, and a pathological disturbance of the cascade, such as that which occurs in hypoventilation, can result in tissue hypoxia [6, 7].
Although pO2 represents only a very small fraction of the total oxygen (ctO2) (see ctO2) being transported in arterial blood, it is highly significant as it is the major determinant of the amount of oxygen bound to hemoglobin (see sO2) and thereby the total amount of oxygen transported by arterial blood and made available to tissue cells. The relationship between pO2 and sO2 is described by the oxyhemoglobin dissociation curve (ODC) (Fig. 4). When pO2(a) is higher than 10 – 11 kPa (75 – 83 mmHg), hemoglobin binds near-maximal amounts of oxygen (i.e. sO2(a) >95 %). However, if pO2(a) falls below ∼10 kPa (75 mmHg) there is a marked decrease in sO2 and therefore a sharp decline in the oxygen-carrying capacity of blood. The delivery of oxygen to tissues becomes increasingly compromised as pO2(a) falls below ∼10 kPa (75 mmHg), not primarily because pO2(a) is decreased but because hemoglobin is carrying significantly less oxygen.
Why measure pO2?
The pO2 is a reflection of the oxygen uptake in the lungs.
- It is the key parameter for assessing the adequacy of blood oxygenation, i.e. the transfer of environmental oxygen from lungs (alveoli) to blood (see oxygen status)
- It provides the means for diagnosing respiratory failure
- It provides the means for monitoring supplemental-oxygen therapy
When should pO2 be measured?
Measurement of pO2 is clinically useful in the diagnosis, assessment and monitoring of patients with severe acute or chronic respiratory disease or respiratory failure due to conditions other than respiratory disease (e.g. trauma to brain or chest, drug overdose).
Terms used in interpretation
Hypoxemia is decreased oxygen content (see ctO2) in blood (Table I). There are two main causes: impaired oxygenation of blood in the lungs and anemia. The first is evident as decreased pO2 and the second is evident as decreased hemoglobin. It is important to be aware that although hypoxemia is usually associated with decreased pO2, it can occur e.g. in patients with severe anemia, carbon monoxide poisoning and methemoglobinemia, despite normal pO2 [8, 9].
Hypoxia  refers to the potentially life-threatening state in which the oxygen delivery to tissue cells is not sufficient to maintain normal aerobic metabolism. Affected tissue cells produce excess lactic acid, leading to increasing lactate levels in blood and resulting in metabolic acidosis (see lactate). Four types of hypoxia are recognized; they are:
Defective mechanism of oxygenation in the lungs, resulting in insufficient oxygen content in the blood (ctO2(a) is low due to low pO2(a))
Insufficient transport of oxygen to tissues, due to inadequate blood flow
Insufficient oxygen content in the blood due to decreased amount of hemoglobin able to carry oxygen
Impaired use of oxygen by tissues
Whatever the mechanism, it can, if sufficiently severe, lead to anoxia (cessation of oxygen supply) and tissue cell death. Myocardial infarction is an example of potentially fatal local tissue hypoxia caused not by hypoxemia, but by ischemia, due to thrombosis of a coronary artery .
Hyperoxemia is increased pO2 in blood, i.e. pO2(a) >16.0 kPa (120 mmHg) (Table I). This can only occur in a clinical setting with administration of supplemental oxygen. It can lead to hyperoxia (increased oxygen content in tissues). Hyperoxia can be associated with oxygen toxicity; premature neonates are particularly vulnerable to the toxic effects of oxygen .
Respiratory failure is failure of the lungs to adequately perform pulmonary gas exchange. It is defined by pO2(a) <8 kPa (60 mmHg). Below the degree of hypoxemia that this level represents, there is increasing risk of hypoxia, even if cardiac output is not compromised. This degree of hypoxemia would usually trigger prescription of supplemental-oxygen therapy to ensure adequate tissue oxygenation. (see CO2 definition of type I and type II respiratory failure).
Causes of hypoxemia 
- Mechanical causes (e.g. airway obstruction, chest trauma)
- Neuromuscular diseases (e.g. Guillain-Barré syndrome, myasthenia gravis)
- Drugs that depress the respiratory center (e.g. opioids)
- Pulmonary embolism
- Pulmonary edema
- Acute asthma
- Acute respiratory distress syndrome (ARDS)
- Chronic obstructive pulmonary disease (COPD)
- Pulmonary disease ( e.g. fibrosis)
Symptoms associated with hypoxemia 
- Breathlessness on minimal exertion
- Shortness of breath/difficulty breathing/respiratory distress (dyspnea)
- Increased respiratory rate (tachypnea)
- Nasal flaring
- Wheeze/crackles on auscultation
- Increased sweating (diaphoresis)
- Confusion, disorientation, somnolence
- Decreased SpO2 (measured by pulse oximetry)
- Increased red cell count (polycythemia) with prolonged chronic hypoxemia
Causes of hyperoxemia
Oxygen therapy and pO2
Too much oxygen may be toxic, causing endothelial damage in the lungs and other tissues. Increased pO2 can only occur if the fraction of inspired oxygen (FO2(I)) and therefore pO2 of alveolar air is increased. The only clinical cause of increased pO2(a) is supplemental-oxygen therapy .
FO2(I) of ambient air is 21 %. Depending on the mode of delivery, oxygen therapy is associated with FO2(I) up to 100 % (pure oxygen). Oxygen therapy poses an issue for interpreting pO2, i.e. to decide if the pO2 is appropriately high for the increased FO2(I). A useful rule of thumb is that the difference between FO2(I) (%) and pO2 measured in kPa should not exceed 10 . If this difference is significantly higher than 10, oxygenation is impaired.
Consider two adult patients receiving oxygen therapy that provides FO2(I) of 30 %. The first patient’s pO2(a) is 13 kPa and the second patient’s pO2(a) is 22 kPa. Using the rule of thumb it is clear that the first patient has impaired oxygenation despite the normal pO2(a). The second patient does not; this patients pO2(a) is appropriately high for the oxygen administration.
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Effective Date January 20th, 2023 (last updated January 20th, 2023)
ABOUT THIS POLICYRadiometer values your privacy and the protection of your personal data. This policy (“Policy”) explains how Radiometer its affiliates, subsidiaries or related companies, a full list of which can be located here (together, “Radiometer”, “our”, “us”, or “we”), collects, uses, shares, transfers and processes data collected from or about you.
“Personal Data” is any information that can be used to directly or indirectly identify an individual or that can be reasonably expected to link to an individual. This can include items such as name, address, telephone number, credit card details, email address, ID number, Internet Protocol (“IP”) address of an electronic device used by an individual, or other identifying code (even absent of other identifying information). Statistical and non-identifiable metric data are not considered Personal Data.
The Radiometer subsidiary, affiliate or related company with which you interact is, where applicable, the data controller (or equivalent under applicable law) responsible for the processing of your Personal Data. You can find a list of the relevant legal entities that act as data controllers in Appendix 1 to this Policy.
SCOPEThis Policy describes the types of Personal Data that we may collect, process or disclose about you and how you may govern this processing by exercising applicable legal rights. This Policy applies to both online and offline information collection, including your use of websites or subdomains operated by us, any mobile applications, when we provide products and/or services to you or notify you about prospective items of interest and in other situations where you interact with us in-person, by telephone or by mail where this Policy is posted or referenced.
There may be occasion where you have been provided with a circumstance-specific privacy notice that is separate from this policy, such as privacy notices for specific activities such as Recruitment. To the extent you were provided with a different notice, those notices apply and govern our interactions with you. If you provide Personal Data about parties other than yourself, you are responsible for ensuring their knowledge of how we will process their personal data, and, where applicable, obtaining any necessary consents required in advance.
We are committed to processing Personal Data in accordance with applicable laws. Please note that if you do not wish to provide your Personal Data to us, some products and/or services may become unavailable to you. Your use of any or all these platforms indicates you have been notified of our collection, use, transfer, and disclosure of your information as described in this Policy to the extent permitted by applicable law.Read more