Intensive Care Medicine | 2021
When could airway plateau pressure above 30 cmH2O be acceptable in ARDS patients?
Abstract
Limitation of plateau pressure (Pplateau) is critical for protection from ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS) [1]. Limiting to a 30 cmH2O threshold is a widely accepted recommendation for lung protection, in addition to the use of low tidal volume (VT) and positive end-expiratory positive pressure (PEEP) [2]. Moreover, Pplateau is in of itself a powerful determinant of mortality in the general ARDS patient population [1], as well as being a component of other parameters associated with the risk of ventilator-induced lung injury and/or the clinical prognosis of ARDS patients, such as driving pressure or mechanical power [3, 4]. In this short piece, we will discuss two conditions in which allowing a Pplateau above 30 cmH2O may be advisable in ARDS patients. The approach to these conditions is based on the concepts that: