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Plateau Pressure Limit ARDS — FRCA Final MCQ

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EasyIntensive Care MedicinePlateau Pressure Limit ARDSFRCA Final

A 55-year-old man in ICU with severe pancreatitis develops respiratory failure requiring intubation. His CT shows diffuse bilateral infiltrates consistent with ARDS. He weighs 85 kg (ideal body weight 72 kg). You set the ventilator. What plateau pressure limit should NOT be exceeded?

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Correct answer: C — 30 cmH2O

The ARDSNet protocol established that plateau pressure should not exceed 30 cmH2O to minimise ventilator-induced lung injury. This limit, combined with tidal volumes of 6 mL/kg IBW and driving pressure <15 cmH2O, forms the cornerstone of lung-protective ventilation. If Pplat exceeds 30 cmH2O despite VT of 6 mL/kg, the tidal volume should be further reduced (to a minimum of 4 mL/kg) to maintain the pressure limit. Higher rates may be needed to maintain minute ventilation, accepting permissive hypercapnia if necessary.

Reference: ARDSNet – 2000 – Low tidal volume ventilation trial; ICS – 2024 – ARDS guidelines