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About

The Oxygenation Index (OI) is a standard physiological calculation used in Intensive Care Units to measure the efficiency of oxygen exchange in the lungs. Unlike the P/F ratio, the OI incorporates Mean Airway Pressure (MAP), making it a superior metric for patients on positive pressure ventilation, particularly neonates and children with acute respiratory distress syndrome (ARDS).

High OI values indicate severe resistance to oxygenation therapy. Clinicians monitor this trend meticulously. An escalating OI despite maximized ventilator settings serves as the primary trigger for escalating to high-frequency oscillatory ventilation (HFOV) or Extracorporeal Membrane Oxygenation (ECMO). Immediate calculation accuracy is vital for these life-support decisions.

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Formulas

The formula normalizes the pressure required to achieve oxygenation against the actual arterial oxygen level.

OI = MAP × FiO2 × 100PaO2

Where:
MAP = Mean Airway Pressure (cmH2O)
FiO2 = Fraction of Inspired Oxygen (0.21 to 1.0)
PaO2 = Partial Pressure of Oxygen (mmHg)

Reference Data

Oxygenation Index (OI)Severity CategoryClinical Action / ConsiderationMortality Risk (Est.)
0 15Mild / NormalStandard Ventilation< 10%
15 25Moderate HypoxiaConsider HFOV / Nitric Oxide15% 30%
25 40Severe HypoxiaHigh Mortality Risk. HFOV indicated.> 40%
> 40Critical FailureECMO Candidacy Criteria> 80% (w/o ECMO)

Frequently Asked Questions

Historically, an OI > 40 consistently demonstrated on at least two blood gases is the threshold for initiating Extracorporeal Membrane Oxygenation (ECMO). Some centers consider > 35 if the patient is deteriorating rapidly.
The PaO2/FiO2 ratio ignores the pressure cost. A patient maintaining good oxygen levels but requiring dangerous amounts of pressure (high MAP) is at risk of barotrauma. OI accounts for this "cost" of ventilation.
While developed for neonates, OI is increasingly used in adult ARDS. However, the thresholds (like OI > 40 for ECMO) are primarily validated in pediatric populations. Adult protocols may vary.