key: cord-1032404-2d088dsd
authors: Acho, Megan; Lee, Alyson C.; Lee, Burton W.
title: Ventilators for Nonintensivists: Troubleshooting Elevations in Plateau Pressure
date: 2020-10-08
journal: ATS scholar
DOI: 10.34197/ats-scholar.2020-0070vo
sha: b047098acafb89c598a6d012df6196b1e381515b
doc_id: 1032404
cord_uid: 2d088dsd

nan

As coronavirus disease has rapidly evolved into a pandemic, many physicians without prior critical care training are being called upon to help manage severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients who develop respiratory failure and require mechanical ventilation. This video is intended to provide a brief and simplified approach to mechanical ventilation for nonintensivists. It is essential to regularly monitor two alveolar pressures in mechanically ventilated patients: the plateau pressure (Ppl) and the total positive endexpiratory pressure (PEEP total ). This video provides an overview of monitoring and troubleshooting elevations in Ppl. Ppl is the alveolar pressure at end inspiration and represents the highest pressure in the alveoli during the respiratory cycle. It is important to monitor Ppl because high Ppl is associated with increased mortality among patients with acute respiratory distress syndrome. One of the goals of ventilation for mechanically ventilated patients is to keep the Ppl <30 cm H 2 O. Mathematically, the components of Ppl may be derived from the equation for compliance. From this equation, we can see that elevations in Ppl can be explained by high TV, high PEEP total, or low compliance (C). Therefore, if the Ppl is elevated, options include reducing the TV, improving compliance, or minimizing PEEP total . In patients with acute respiratory distress syndrome, the recommended TV is 6 ml/kg of predicted body weight. If the Ppl is elevated despite this TV, it may be reduced to 5 or even 4 ml/kg, provided that the patient's acid-base status tolerates such a change. A conservative fluid management approach is also recommended to increase compliance and shorten the duration of mechanical ventilation. Finally, PEEP total should be minimized by avoiding autoPEEP.

Author disclosures are available with the text of this article at www.atsjournals.org.

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