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Patient Particulars

Vital signs (upon admission to ICU)

FiO2 is to be written in decimals. 100% = 1.0, 50% = 0.5, 10% = 0.1, etc
Refer to the chart below for your FiO2 score

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Oxygen tank flow rate in liters/min

FiO2

Nasal cannula

0 L/min

21

1 L/min

24

2 L/min

28

3 L/min

32

4 L/min

36

5 L/min

40

6 L/min

44

Face mask

5 L/min

40

6 L/min

50

7-8 L/min

60

Nasopharyngeal catheter

4 L/min

40

5 L/min

50

6 L/min

60

Venturi mask

FiO2 as set on the apparatus

Face mask with reservoir

6 L/min

60

7 L/min

70

8 L/min

80

9 L/min

90

10 L/min

95

15 L/min (non-rebreather mask)

100

High flow nasal cannula, non-invasive ventilation, mechanical ventilation

Regardless of inspiratory flow, positive end-expiratory pressure (PEEP)

FiO2 as set on the apparatus

Severity of illness scores

Please calculate your scores and enter them in the fields below. Calculators are provided if necessary.

SIRS Calculator
Please enter result as a score. 1 point per each matching criteria.

Site of infection

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Positive cultures

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Measurements at time zero

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 : 
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Resources used in ICU (anytime in the current ICU stay)

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Limitation of life-sustaining treatments

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Outcome & Discharge