Interactive PF Ratio Calculator

Calculate the PaO2/FiO2 ratio to assess oxygenation status and ARDS severity according to Berlin criteria. Clinical tool for ICU and respiratory assessment. Learn more about ARDS diagnosis at Medscape.

Partial pressure of oxygen from ABG. Normal: 80-100 mmHg
Fraction of inspired oxygen (21% = room air, 100% = pure oxygen)

PF Ratio Formula & Berlin ARDS Criteria

Understanding oxygenation assessment and ARDS severity classification

PF Ratio Definition

The PF ratio (PaO2/FiO2) quantifies oxygenation efficiency by comparing arterial oxygen concentration to inspired oxygen concentration:

PF Ratio = PaO₂ (mmHg) ÷ FiO₂ (decimal)

Berlin ARDS Criteria (2012)

PF Ratio ARDS Severity Mortality Rate Clinical Features Ventilation Strategy
> 300 No ARDS Baseline Normal oxygenation Standard support
200 – 300 Mild ARDS 27% Bilateral infiltrates Consider CPAP
100 – 200 Moderate ARDS 32% Refractory hypoxemia Lung-protective ventilation
< 100 Severe ARDS 45% Severe hypoxemia ECMO consideration

Key Facts: The Berlin criteria require: (1) Acute onset within 7 days, (2) Bilateral infiltrates on imaging, (3) Respiratory failure not fully explained by cardiac failure, (4) PF ratio ≤300 on PEEP ≥5 cmH₂O. PF ratio correlates with lung weight and shunt fraction. Each 50-point decrease increases mortality by 8-12%.

How to Use the PF Ratio Calculator

Simple steps for accurate ARDS assessment

1

Enter PaO₂ Value

Input arterial oxygen tension from ABG analysis in mmHg

2

Enter FiO₂ Value

Input fraction of inspired oxygen as percentage (21-100%)

3

Assess ARDS Severity

View PF ratio with Berlin criteria classification and clinical recommendations

Advantages of PF Ratio

Why clinicians rely on this vital oxygenation index

Quick and Simple

Probably the main reason for its widespread use in ICU settings worldwide.

Rough Guide to A-a Gradient

Can be used as a rough guide to whether there is a significant A-a gradient present: PaO2 should = FiO2 x 500 (e.g. 0.21 x 500 = 105 mmHg). See caveats in clinical guidelines.

More Practical than a/A Ratio

More practical than the a/A ratio, as measurement of alveolar oxygen tension (PAO2) is not required.

Used in Severity Scoring

Integral to APACHE IV, SOFA, SAPS-II and SAPS-III scoring systems for critical illness prognosis.

Clinical Applications & Mortality Correlation

The PF ratio is part of the Berlin definition of Acute Respiratory Distress Syndrome (ARDS) and correlates directly with mortality risk.

ARDS Severity PaO2/FiO2 Mortality PEEP Requirement
Mild 200 – 300 27% ≥5 cmH₂O
Moderate 100 – 200 32% ≥5 cmH₂O
Severe < 100 45% ≥5 cmH₂O

Note: The Berlin definitions require PF ratio measurement with a PEEP setting of 5 cmH₂O or more.

Frequently Asked Questions

The PF ratio (PaO₂/FiO₂) quantifies oxygenation efficiency by comparing arterial oxygen concentration to inspired oxygen concentration. It’s critical for diagnosing and monitoring ARDS severity, guiding ventilator management, and predicting mortality. Lower ratios indicate worse lung function and higher shunt fraction.

Berlin criteria (2012) define ARDS by: (1) Acute onset within 7 days of insult, (2) Bilateral infiltrates on imaging not explained by effusions/collapse, (3) Respiratory failure not fully explained by cardiac failure/fluid overload, (4) PF ratio ≤300 on PEEP ≥5 cmH₂O. Severity: Mild (200-300), Moderate (100-200), Severe (<100).

PF Ratio = PaO₂ (mmHg) ÷ FiO₂ (decimal). If FiO₂ is given as percentage, divide by 100 first. Example: PaO₂ = 85 mmHg on 40% oxygen → 85 ÷ 0.40 = 212.5. This falls into Mild ARDS category. Always ensure PaO₂ is from arterial blood gas and FiO₂ is the actual delivered oxygen concentration.

A PF ratio <100 indicates severe ARDS with 45% mortality risk. Patients require invasive mechanical ventilation with lung-protective strategy (tidal volume 6mL/kg, plateau pressure ≤30 cmH₂O), prone positioning for >12 hours daily, and consideration of ECMO. This represents severe hypoxemia refractory to conventional ventilation.

Oxygenation Index (OI) = [FiO₂ × Mean Airway Pressure × 100] ÷ PaO₂. OI is used in pediatrics and includes ventilator pressure, making it more comprehensive for assessing ventilation support. PF ratio is simpler and used in adults for ARDS diagnosis. OI >40 indicates severe ARDS in children and often triggers ECMO consideration.

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