How to measure peak
- Peak pressure is the maximum pressure during inspiration and is usually displayed every breath.
- A high peak with normal plateau suggests resistance: tube kink, mucus, bronchospasm, biting, small ETT.
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Vent control
Peak and plateau pressure
Peak pressure reflects resistance plus compliance. Plateau pressure estimates alveolar pressure after an inspiratory hold.
How to measure plateau
- Use an inspiratory hold maneuver on a passive/synchronous patient.
- Hold long enough to see the pressure plateau, then read plateau pressure.
- High plateau suggests low compliance or high alveolar pressure: ARDS, edema, pneumothorax, abdominal pressure, mainstem, overdistension.
Pitfalls
- Measuring plateau while the patient is actively breathing or coughing.
- Treating high peak pressure without distinguishing resistance from compliance.
- Forgetting auto-PEEP/stacking in obstructive physiology.