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Vent control

High resistance branch

PIP rises while plateau remains near baseline or is much less elevated: look between the ventilator and alveoli.

Obstruction waveformProlonged expiratory limb or scooped flow-volume loop.Secretions / mucus / bloodSuction and tube-patency pathway.Tube / circuit kink or biteCheck tube, bite block, filter, and tubing.If oxygenation is failingOpen hypoxia rescue.

Common causes

  • Bronchospasm or obstructive physiology.
  • Secretions, mucus plug, blood, or ETT obstruction.
  • Tube kink, patient biting, small ETT, filter/HME or circuit resistance.
  • High inspiratory flow can increase PIP without raising Pplat.

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]