UMEM Educational Pearls

Category: Critical Care

Title: Peak and Plateau Pressures in Intubated ED Patients with Respiratory Distress

Posted: 10/5/2010 by Mike Winters, MD (Updated: 4/18/2024)
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Respiratory Distress in the Ventilated ED Patient

In the ventilated patient with respiratory distress, evaluation of peak and plateau pressures can help to identify the cause.
Isolated increases in peak pressure suggest increased resistance to airflow and should prompt consideration of the following:
- kinked or twisted ET tube
- patient biting ET tube
- obstructed ET tube
- bronchospasm
- lower airway obstruction
Increases in plateau pressure suggest decreased pulmonary compliance and should prompt consideration of the following:
- unilateral intubation
- pneumothorax
- pulmonary edema
- worsening pneumonia
- abdominal HTN/compartment syndrome

Santanilla JI, Daniel B, Yeow ME. Mechanical ventilation. Emerg Med Clin N Am 2008;26:849-862.