Plateau Pressure

Plateau pressure (Pplat) is the pressure applied to small airways and alveoli during mechanical ventilation when airflow is momentarily paused at the end of inspiration. It reflects lung compliance and helps assess the risk of ventilator-induced lung injury (VILI).

• Measured using an inspiratory pause maneuver (0.5–1 second) on a ventilator.
• Represents static lung compliance (not affected by airway resistance).
• Formula for Driving Pressure (ΔP):
  • ΔP = Pplat - PEEP *
• Driving pressure is a key predictor of mortality in ventilated patients.

• General ICU Patients & ARDS:
  • Pplat ≤ 30 cmH₂O (to reduce risk of lung overdistension and barotrauma).
• Acute Brain Injury (ABI) Patients (e.g., TBI, ICH, SAH, Stroke):
  • Pplat ≤ 25 cmH₂O (to minimize effects on cerebral perfusion).
  • Avoid excessive PEEP to prevent increased intracranial pressure (ICP).

• Higher Pplat was associated with increased ICU and 6-month mortality.
• No strong correlation with neurological outcomes.
• Suggests ventilation practices should balance lung protection with cerebral hemodynamics.

• Decreased Lung Compliance: ARDS, pneumonia, pulmonary edema, lung fibrosis.
• Excessive Tidal Volume: Overdistension of alveoli.
• High PEEP: Can elevate Pplat and affect venous return.
• Air Trapping (Auto-PEEP): Common in obstructive lung diseases.

• Reduce Tidal Volume (VT): Target 4-6 mL/kg of predicted body weight (PBW) .
• Adjust PEEP Carefully: Avoid excessive PEEP in ABI.
• Optimize Sedation & Paralysis: If needed, to reduce patient-ventilator dysynchrony.
• Consider Recruitment Maneuvers: If compliance is severely decreased (ARDS patients).

• Pplat ≤ 30 cmH₂O is the general ICU goal.
• For ABI patients, Pplat ≤ 25 cmH₂O may be preferable to avoid secondary brain injury.
• Higher Pplat increases mortality risk but its effect on neurological outcomes remains uncertain.