Ventilator Management and Plateau Pressure Measurement

Understanding Plateau Pressure

• Plateau pressure reflects alveolar pressure at end-inspiration and is primarily determined by lung/chest wall compliance 1
• Maintaining plateau pressures <30 cmH2O is recommended to prevent ventilator-induced lung injury in ARDS patients 2, 1
• For patients without ARDS, aim for plateau pressures below 25 cmH2O 2

Step-by-Step Procedure for Measuring Plateau Pressure

• Ensure the patient is relaxed and not actively breathing against the ventilator, and briefly sedate if necessary to prevent spontaneous breathing efforts that can interfere with measurement 3, 4

Clinical Applications

• Use plateau pressure to guide ventilator settings and prevent ventilator-induced lung injury, assess lung compliance, titrate PEEP levels, and monitor response to interventions such as bronchodilators or recruitment maneuvers 2, 1
• The American Thoracic Society recommends using plateau pressure to assess lung compliance and guide ventilator settings 1

Common Pitfalls and Solutions

• Patient-ventilator asynchrony can lead to inaccurate readings, ensure the patient is not actively breathing during measurement 3, 4
• The American College of Chest Physicians suggests checking for leaks in the ventilator circuit that could lead to falsely low plateau pressure readings 1

When to Measure Plateau Pressure

• Measure plateau pressure after any significant change in ventilator settings, when assessing response to treatments, routinely in patients with ARDS, and when evaluating unexplained increases in peak airway pressure 2, 1