After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a VT of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H2O. Which of the following actions would you recommend to the patient's physician?
a. Decrease the inspiratory flow.
b. Lower the delivered VT.
c. Administer a bronchodilator.
d. Add PEEP.
ANS: B
Plateau pressure (Pplat) during mechanical ventilation reflects alveolar pressure, the best bedside clinical reflection of transalveolar pressure. Limiting Pplat reduces the likelihood of ventila-tor-induced lung injury, although patients with decreased thoracic compliance may require plat-eau pressures greater than 30 cm H2O without resulting overdistention.
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