In previous pearls, we have highlighted ventilator settings for the asthmatic, along with the differences between peak and plateau pressure measurements.
When ventilating the asthmatic, pay attention to the ventilator settings placed by your respiratory therapist.
In general, the respiratory therapist will set the ventilator to stop delivering tidal volumes when the peak pressure exceeds 40-60 cm H2O.
For asthmatics, this practice can result in very low tidal volumes.
Thus, peak pressure limits must be set higher.
As you know, high peak pressures have not been shown to be injurious, provided that the plateau pressure remains < 30 cm H2O
References
Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation. JEM 2010; 38:622-31.
