Centimeter Water (4 °C) to Millimeter Mercury

Respiratory medicine adopted cmH₂O because the original ventilators literally used water columns to regulate pressure — a jar of water with a submerged tube set the pressure at whatever depth the tube was immersed. A CPAP setting of 10 cmH₂O meant the air bubbled out at 10 cm depth. The unit stuck even after electronics replaced water seals, because clinicians, patients, and device manuals all speak the same scale.

Most adults are prescribed between 6 and 14 cmH₂O, with 10 cmH₂O being a common starting point. Severe obstructive sleep apnoea may require 15–20 cmH₂O. Auto-titrating (APAP) machines vary pressure within a set range — typically 4–20 cmH₂O — adjusting breath by breath. Higher pressures are more effective at splinting the airway open but can cause discomfort and air swallowing.

ICU ventilators also use cmH₂O. Positive end-expiratory pressure (PEEP) is usually set at 5–15 cmH₂O to keep alveoli open. Peak inspiratory pressure above 30–35 cmH₂O raises the risk of lung injury. Plateau pressures are monitored to stay below 30 cmH₂O. The entire field of mechanical ventilation runs on this single unit because it directly corresponds to the pressures inside the lung.

Measured via lumbar puncture with the patient lying on their side, normal CSF pressure is 10–18 cmH₂O in adults. Above 25 cmH₂O suggests raised intracranial pressure — potentially from a tumor, meningitis, or hydrocephalus. Below 6 cmH₂O indicates low pressure, often from a CSF leak. Neurologists use cmH₂O rather than mmHg because spinal fluid is essentially water, making the unit a direct physical analogue.

1 cmH₂O ≈ 0.981 mbar ≈ 0.0981 kPa. For bedside estimates, 1 cmH₂O ≈ 1 mbar is close enough (error under 2%). A CPAP setting of 12 cmH₂O is about 11.8 mbar or 1.18 kPa. Since respiratory equipment universally reads cmH₂O, conversion is mainly needed when interfacing with industrial instruments or when charting pressures alongside blood gas data reported in mmHg.

Clinical medicine is deeply conservative about units because misreadings kill people. Doctors, nurses, and patients worldwide have memorized "120/80 is normal" in mmHg. Converting to kPa (16.0/10.7) would require retraining millions of clinicians and rewriting every guideline. The WHO considered the switch and decided the risk of transcription errors during transition outweighed the elegance of SI compliance. So mmHg stays — likely for decades more.

The top number (systolic) is the peak pressure when the heart contracts and pushes blood into the arteries — typically 90–120 mmHg. The bottom number (diastolic) is the lowest pressure between beats when the heart relaxes — typically 60–80 mmHg. A reading of 140/90 mmHg or above is classified as hypertension. The gap between the two (pulse pressure) also matters: a wide gap above 60 mmHg may signal stiff arteries.

In 1643, Evangelista Torricelli filled a glass tube with mercury, inverted it into a dish of mercury, and watched the column drop to about 760 mm. The empty space above was the first laboratory vacuum. The height of the mercury column became the measurement of atmospheric pressure — 760 mmHg at sea level. Nearly 400 years later, we still use his column height as a pressure unit in medicine and vacuum science.

For all practical purposes, they are identical — 1 torr = 1/760 atm ≈ 133.322 Pa, and 1 mmHg ≈ 133.322 Pa. The difference is about 0.00015% and arises from the torr being defined from the atmosphere while mmHg is defined from mercury density. Medicine uses mmHg; vacuum physics uses torr. They are interchangeable in any real-world measurement.

Intraocular pressure (glaucoma screening): normal is 10–21 mmHg, above 21 is suspicious. Partial pressure of oxygen in arterial blood (PaO₂): normal is 80–100 mmHg. Central venous pressure: 2–6 mmHg. Intracranial pressure: normal below 15 mmHg, dangerous above 20 mmHg. Carbon dioxide in blood (PaCO₂): 35–45 mmHg. The unit pervades clinical monitoring far beyond the blood pressure cuff.