How do you check plateau pressure on a ventilator?

How to Check Plateau Pressure on the Ventilator Servo I

To check plateau pressure on the Servo I ventilator, use the end-expiratory airway occlusion technique by pressing the inspiratory hold button at the end of inspiration for 0.5-2 seconds and reading the plateau pressure from the ventilator display. 1, 2

Understanding Plateau Pressure

• Plateau pressure reflects alveolar pressure at end-inspiration and is primarily determined by lung/chest wall compliance 1
• Maintaining plateau pressures <30 cmH2O is recommended to prevent ventilator-induced lung injury in ARDS patients 3, 1
• For patients without ARDS, aim for plateau pressures below 25 cmH2O 3

Step-by-Step Procedure for Measuring Plateau Pressure

1. Prepare the patient:

   • Ensure the patient is relaxed and not actively breathing against the ventilator 4
   • If necessary, briefly sedate the patient to prevent spontaneous breathing efforts that can interfere with measurement 4

2. Perform the measurement:

   • Wait until the end of inspiration (peak of the inspiratory cycle) 2
   • Press the inspiratory hold button on the Servo I ventilator 4, 2
   • Hold for 2-3 seconds to allow pressure equilibration 2
   • Read the plateau pressure value displayed on the ventilator screen 2

3. Interpret the results:

   • The difference between the end-inspiratory occlusion plateau pressure and the airway pressure before the occlusion (PEEP + PS) can be used as an estimate of inspiratory effort 2
   • Calculate driving pressure (plateau pressure - PEEP) as it's a strong predictor of outcomes in ARDS patients 3, 1

Clinical Applications

• Use plateau pressure to:
  • Guide ventilator settings and prevent ventilator-induced lung injury 3, 1
  • Assess lung compliance (tidal volume divided by plateau pressure minus PEEP) 1
  • Titrate PEEP levels appropriately 3
  • Monitor response to interventions such as bronchodilators or recruitment maneuvers 1

Common Pitfalls and Solutions

• Patient-ventilator asynchrony: Ensure the patient is not actively breathing during measurement as this can lead to inaccurate readings 4
• Insufficient hold time: Hold for at least 2 seconds to allow for pressure equilibration throughout the lungs 2
• Circuit leaks: Check for leaks in the ventilator circuit that could lead to falsely low plateau pressure readings 1
• Cardiac oscillations: Small fluctuations in the plateau pressure reading due to cardiac contractions are normal and should not affect interpretation 4

When to Measure Plateau Pressure

• After any significant change in ventilator settings 3
• When assessing response to treatments 1
• Routinely in patients with ARDS to ensure lung-protective ventilation 3
• When evaluating unexplained increases in peak airway pressure 1