American Board of Internal Medicine (ABIM) Certification Practice Exam

What plateau pressure setting is recommended for patients with ARDS?

1. Less than 20 cm H2O

2. Less than 30 cm H2O

3. Less than 40 cm H2O

4. Less than 50 cm H2O

The correct answer is: Less than 30 cm H2O

In the management of Acute Respiratory Distress Syndrome (ARDS), it is crucial to minimize ventilator-induced lung injury while ensuring adequate oxygenation and ventilation. The recommended plateau pressure setting for patients with ARDS is less than 30 cm H2O. This threshold is based on studies that have demonstrated that higher plateau pressures are associated with increased risk of ventilator-associated lung injury and poorer outcomes in patients with ARDS. Maintaining the plateau pressure below this level helps prevent overdistension of the alveoli, which is particularly important in ARDS where the lung tissue is already compromised. Keeping the plateau pressure at or below this value is a critical component of lung-protective ventilation strategies, which focus on using lower tidal volumes and appropriate positive end-expiratory pressure (PEEP) settings. Plateau pressures above 30 cm H2O have not been well-tolerated and can lead to further lung injury and inflammation, making adherence to the lower threshold a key aspect in the management of these patients. By targeting a plateau pressure of less than 30 cm H2O, healthcare providers aim to balance the need for effective ventilation with the need to protect the lungs from additional injury during mechanical ventilation.