What is the plateau pressure threshold recommended to minimize ventilator-induced lung injury in ARDS?

• A. ≤20 cm H2O
• B. ≤30 cm H2O
• C. ≤40 cm H2O
• D. ≤50 cm H2O

Answer: (B)

In protective ventilation for ARDS, the goal is to minimize alveolar overdistension and ventilator-induced lung injury by keeping plateau pressure at or below 30 cm H2O. Plateau pressure is the pressure measured during an inspiratory hold when there is no airflow, and it reflects the pressure applied to the small airways and alveoli. When this pressure stays at or below 30 cm H2O, the risk of volutrauma and barotrauma is reduced while maintaining enough ventilation with a low tidal volume. If plateau pressure starts to climb above this threshold, you would lower the tidal volume (typically to about 6 mL/kg predicted body weight) and adjust PEEP carefully to improve oxygenation without pushing pressures higher. In ARDS, higher plateau pressures are linked to worse outcomes because they indicate greater alveolar stretch, whereas keeping pressures within this limit supports lung-protective mechanics.