Plateau Pressure Exceeding Peak Inspiratory Pressure During Pressure Mode Ventilation With Active Inspiratory Effort.
Hassan Sajjad, Tracy Steffes, Samuel Haen et al.
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From the abstract
In patients receiving pressure modes of mechanical ventilation, plateau pressure can be higher than peak inspiratory pressure when the patient has a strong drive to breathe. This report provides comprehensive evidence to support this observation.
Reported results
Positive end-expiratory pressure was 5 cm H2O for all pressure support settings. At pressure support of 0 cm H2O, plateau pressure was 13 cm H2O; peak inspiratory pressure was 5 cm H2O. The difference between plateau pressure and peak inspiratory pressure (8 cm H2O) reflected the patient's inspiratory effort. The driving pressure (8 cm H2O) generated a tidal volume of 619 mL.
Authors' conclusions
When plateau pressure can be accurately measured, the difference between plateau pressure and peak inspiratory pressure can be used at the bedside to evaluate a patient's respiratory drive. Ensuring protective goals by routinely monitoring plateau pressure regardless of the mode of mechanical ventilation is critical.