RUMUS

Kadar oxygen delivery (DO2) sangat ditentukan dari fungsi jantung, hemoglobin dan
saturasi oksigen dalam pembuluh darah arteri. PaO2 berpengaruh sedikit sekali
bahkan dalam beberapa literatur diabaikan. Oleh karena itu untuk meningkatkan
kadar oxygen delivery (DO2) perlu penanganan secara optimal pada penderita
cedera kepala, terutama pengelolaan prehospital. Tujuan terpenting pengelolaan
prehospital (awal kejadian cedera, tranportasi ke RS ataupun rujukan ke pelayanan
bedah saraf) adalah mempertahan jalan nafas dan oksigenasi yang adekuat serta
menjaga tekanan darah yang dapat mempertahankan tekanan perfusi otak.

Rob Law, H.Bukwirwa, Physiology of Oxygen Delivery, www.emedicine.com,

downloaded May 20th, 2008
B.K Siesjo, Mechanism of secondary brain injury, www.emedicine.com, downloaded
May 20th, 2008

Oxygen delivery (DO2) adalah jumlah total oksigen yang dialirkan darah ke jaringan
setiap menit. Kadar oxygen delivery tergantung dari cardiac output (CO) dan
oxygen content of the arterial blood (CaO2). Komponen dari CaO2 adalah oksigen
yang berikatan dalam serum (2-3%) yang dapat ditelusuri dengan kadar PaO2 dan
oksigen yang berikatan dengan hemoglobin (97-98%) yang dapat ditelusuri dengan
SaO2 (saturasi oksigen pada pembuluh darah arteri). Dari definisi ini dapat
dijabarkan sebuah rumus : DO2 = CO X (Hb X 1,34 X SaO2) + (PaO2 X 0,0031) Nilai
normal oxygen delivery (DO2) adalah 1000 ml O2/menit. Dari rumus diatas dapat
dilihat bahwa hemoglobin (Hb) dan saturasi oksigen (SaO2) adalah penentu utama
pada pengaliran oksigen dalam darah ke seluruh jaringan tubuh termasuk otak.

8) Simon M, Andrew B, Mark CB. Intensive Care, 2nd ed, Elsevier Churchill
Livingstone, 2006
9) Alex B. Valadka, Bian T.Andrews, Neurotrauma, Thieme Medical Publisher, 2005
10)Lynelle N.B, Mechanical Ventilation and Intensive Respiratory Care, WB Saunders
Company, 1995
12)Rob Law, H.Bukwirwa, Physiology of Oxygen Delivery, www.emedicine.com,
downloaded May 20th, 2008

Prevention, early identification, and correction of tissue hypoxia

Key steps in oxygen transport:

Uptake in the lungs

Carrying capacity of blood

Global delivery from lungs to tissue

Regional distribution of oxygen delivery

Diffusion from capillary to cell

Cellular use of oxygen

PO 2 (kPa)

Dry air

21.3

Inspired air (humidified)

20

Alveolar air

14.7

Effect of increasing levels of supplemental oxygen and transfusion in an anaemic

hypoxaemic patient showing importance of saturation and haemoglobin concentration

Air

FiO2 PaO2 (kPa)

SaO2 (%) Hb (g/l) Dissolved O2 (ml/l)

CaO 2 (ml/l)

CaO 2 (% exchange)

0.21 6

75

83

80

1.4

35% O2

0.35 9.5

93

80

2.2

103

24

60% O2

0.6

16.5

98

80

3.8

110

Transfusion

0.6

16.5

98

120

3.8

164

48

CaO2=(haemoglobin (Hb)saturation (SaO2)1.36)+(PaO20.023) ml/l, where 1.36ml is the

volume of oxygen carried by 1g of 100% saturated haemoglobin and PaO20.023 is the oxygen
dissolved in 100ml of plasma.

Note that the normal extraction fraction for O2[(CaO2 C O2)/CaO2] is 5 mL 20 mL,
or 25%; thus, the body normally consumes only 25% of the O 2 carried on
hemoglobin. When O2 demand exceeds supply, the extraction fraction exceeds 25%.
Conversely, if O2 supply exceeds demand, the extraction fraction falls below 25%.

Oxygen Stores
The concept of O2 stores is important in anesthesia. When the normal flux of O2 is
interrupted by apnea, existing O2 stores are consumed by cellular metabolism; if stores are
depleted, hypoxia and eventual cell death follow. Theoretically, normal O2 stores in adults are
about 1500 mL. This amount includes the O2 remaining in the lungs, that bound to hemoglobin
(and myoglobin), and that dissolved in body fluids. Unfortunately, the high affinity of
hemoglobin for O2 (the affinity of myoglobin is even higher) and the very limited quantity of O2
in solution restrict the availability of these stores. The O2 contained within the lungs at FRC
(initial lung volume during apnea), therefore, becomes the most important source of O2. Of that
volume, however, probably only 80% is usable.

Carbon Dioxide Stores

Carbon dioxide stores in the body are large (approximately 120 L in adults) and primarily
in the form of dissolved CO2 and bicarbonate. When an imbalance occurs between production
and elimination, establishing a new CO2 equilibrium requires 2030 min (compared with less
than 45 min for O2; see above). Carbon dioxide is stored in the rapid-, intermediate-, and slowequilibrating compartments. Because of the larger capacity of the intermediate and slow

compartments, the rate of rise in arterial CO2 tension is generally slower than its fall following
acute changes in ventilation.

Ganong WF: Review of Medical Physiology, 20th ed. McGraw-Hill, 2001.

Guyton AC: Textbook of Medical Physiology, 10th ed. W.B. Saunders, 2000.
Nunn JF: Applied Respiratory Physiology, 5th ed. Lumb A (editor). ButterworthHeinemann, 2000.
West JB: Respiratory PhysiologyThe Essentials, 6th ed. Lippincott, Williams & Wilkins,
2000.