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Vent control

Overdistension / beaking branch

A pressure-volume loop may show a late flattening or “beak” when pressure rises with little additional volume.

See overdistension loopCompare with a reference P-V loop.Check PBW and VTTidal volume must be based on predicted body weight.Reassess safety monitoringPplat, driving pressure, PEEP, VT, and hemodynamics.

Think

  • VT or inspiratory pressure may be too high for current lung size/mechanics.
  • Reassess plateau and driving-pressure trends rather than relying on loop shape alone.
  • Reduce VT/pressure when appropriate and coordinate the broader oxygenation strategy with RT/ICU/local protocol.

Evidence and use limits

Last reviewed: 2026-07-17. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational cognitive aid, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]