Plateau pressure is defined as the amount of pressure required to maintain lung inflation in the absence of airflow. It can be measured during mechanical ventilation by applying an inspiratory hold or by closing the exhalation port on inspiration for half a second to two seconds. I wrote this article to give an overview of plateau pressure and discuss how it should be managed in ventilated patients, so if you’re ready, let’s start as above.
Plateau pressure is the pressure in the lungs during mechanical ventilation, which can be measured by taking an inspiratory pause at the end of inspiration. It is also known as peak alveolar pressure and is the best clinical representation of transpulmonary pressure at the bedside; the exact plateau pressure cannot be measured while the patient is breathing.
Therefore, sedation may be required to measure plateau pressure if the patient has an active respiratory impulse, as it may temporarily overwhelm the patient’s effort to breathe, so that plateau pressure can be obtained during the pause at the end of the breath, so you may wonder why plateau pressure is important. Plateau pressure is important because it can help determine the amount of pressure needed to maintain lung inflation in the absence of airflow.
It serves as an excellent estimate of the level of ventilation pressure at the patient’s bedside, which can be potentially harmful to the patient’s lungs. This is important because too much pressure can result in injury to the barrel and undue stress. However, plateau pressure limitation reduces the risk of ventilator-induced lung injury, so lower plateau pressure often results in better patient outcomes. The plateau pressure is less than 30 centimeters of water pressure. However, the normal plateau pressure range is 25 to 30.
If your plateau pressure is above 30, you increase the risk of trunk injury and lung damage caused by a ventilator, so now let’s look at what causes plateau pressure to rise. Increased plateau pressure may be due to conditions that cause prolonged stiffness and reduced lung compliance.
Some examples include pulmonary fibrosis and ardas pulmonary fibrosis is a condition characterized by damage to lung tissue that makes it difficult for the lungs to expand ardas is a severe lung condition characterized by fluid in the alveoli leading to refractory hypoxemia, reduced lung compliance and severe oxygen deficiency.
Now we need to discuss how to measure plateau pressure on a ventilator to measure plateau pressure, the clinician operating the ventilator should use inspiratory pulse control after exhalation, but before exhalation, this inspiratory hold should not last long, usually in the range of half a second to two seconds this allows enough time for the measurement to be obtained. The readings are displayed on a screen where they can be interpreted by respiratory therapists and other healthcare professionals.
However, it can also be calculated using the following formula: plateau pressure equals tidal volume divided by static compliance plus peep. For example, suppose a patient has a tidal volume of 500, static compliance of 22, and a peak of five, to calculate the plateau pressure, you can simply enter numbers into the formula, which would look like this: plateau pressure is 500 divided by 22 plus 5,when you calculate this equals 27.7 centimeters of water pressure.
However, it is important to note that the numbers must be correct for the calculation to be accurate. Another topic we should mention is the maximum pressure. How well are peak and plateau pressures related? Peak pressure or peak inspiratory pressure is the highest pressure that occurs It represents the amount of pressure required to overcome airway resistance and chest wall compliance to allow breathing.
Plateau pressure, on the other hand, is the pressure in the lungs in the absence of airflow, as mentioned above, measured by pausing inspiration at the end of inspiration, the maximum pressure is reached during inspiration, but then the pressure decreases to plateau pressure during inspiration hold, so The plateau pressure should always be less than the peak pressure during volumetric controlled ventilation, since airway resistance affects peak pressure like air. it flows through the lungs.
However, plateau pressure can exceed peak pressure in pressure-controlled ventilation modes if the patient’s inspiratory efforts cause large tidal volumes and significantly negative pleural pressure. it is not affected by airway resistance as it is measured during a period of no airflow, so to sum it up, here are a few rules of thumb to keep in mind. Pressure in the lungs after the release of tidal volume; a normal pressure plateau with elevated peak pressure indicates increased airway resistance.
On the other hand, elevated plateau pressure and elevated peak pressure indicate that the patient has a lung compliance problem. Another topic that I should briefly mention is driving pressure. The driving pressure in mechanical ventilation is measured by subtracting the positive pressure and the expiratory pressure from the plateau. In other words, boost pressure equals plateau pressure minus peak. Often the amount of energy that is supplied to the lungs is taken into account.
Therefore, the higher the driving pressure, the more energy is applied to the lungs. This risk The conduction pressure must be maintained below 15 centimeters of water pressure. This can be achieved by using a lower title volume with appropriate audio levels. Another common question I get is what is an inspiratory pause on mechanical ventilation. As mentioned above, it is an inspiratory impulse.
A control mechanism on the ventilator that allows clinicians to measure pressure at the patient’s plateau, although it is rarely used for therapeutic purposes, and the inspiratory pulse maneuver can also be used for the following clinical purposes inspiration during a chest x-ray. However, the most common reason for performing an inspiratory impulse is, of course, plateau pressure measurement, which we have discussed in detail in this article. patients with spontaneous breathing.