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Vent control

Plateau pressure

Pplat estimates static alveolar pressure after an inspiratory hold when flow is zero.

Pplat near baseline or much less elevatedResistance branch.Pplat elevatedCompliance/alveolar-pressure branch.High plateau or beaking concernOverdistension branch.

Plateau measurement

Plateau measurement

Use an inspiratory hold only when the patient is passive or sufficiently synchronous and there is no major leak.

Original Airway of the Month teaching diagrams redrawn from standard ventilator scalar and loop conventions. Interpretation is anchored to the AARC 2024 Patient–Ventilator Assessment guideline, the peer-reviewed Basics of Ventilator Waveforms review, the 2026 SYNAPsE asynchrony consensus, and the University of Pennsylvania Ventilator Overview and Troubleshooting tip sheet. Waveforms are pattern-recognition aids, not diagnoses; display colors, labels, and orientation vary by ventilator brand.

How to measure

  • Perform an end-inspiratory hold with RT/ventilator-specific technique.
  • Confirm inspiratory flow is zero and wait briefly for pressure equilibration.
  • For ARDS lung-protective ventilation, a plateau-pressure target of 30 cm H₂O or less is generally recommended.

Pitfalls

  • Active effort, coughing, dyssynchrony, or a major leak can invalidate Pplat.
  • A high peak pressure without plateau measurement cannot reliably distinguish resistance from compliance.

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]