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High airway pressure on ventilator — FRCA Final MCQ

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ModerateICUHigh airway pressure on ventilatorFRCA Final

A 73-year-old woman on pressure-controlled ventilation develops sudden high airway pressure alarms. Peak pressure is 45 cmH2O but plateau pressure is 22 cmH2O, SpO2 is 93%, and the capnogram has a sloping expiratory upstroke. The tracheal tube is at the same depth. What is the most likely cause of the complication?

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Correct answer: D — Increased airway resistance from bronchospasm or secretions

High peak pressure with a relatively normal plateau pressure indicates increased airway resistance rather than reduced compliance. Bronchospasm, secretions, biting or tube obstruction are likely. Pneumothorax, pulmonary oedema and ARDS usually raise plateau pressure as well. Separating peak from plateau pressure is a useful bedside ventilator diagnostic step.

Reference: Faculty of Intensive Care Medicine ventilation guidance; RCoA Final FRCA Syllabus 2026