Adult Critical Care Specialty (ACCS) Practice Exam

Which parameter is most important for preventing barotrauma in patients with ARDS?

1. Maximal inspiratory pressure

2. Plateau pressure

3. Mean airway pressure

4. Dynamic compliance

The correct answer is: Plateau pressure

Plateau pressure is the most crucial parameter for preventing barotrauma in patients with Acute Respiratory Distress Syndrome (ARDS). In this context, plateau pressure reflects the pressure in the lungs during a pause in airflow, allowing for a more accurate evaluation of lung compliance without the influence of airway resistance. Maintaining plateau pressure below a certain threshold, typically 30 cm H2O, is essential because elevated plateau pressures can indicate excess pressure being exerted on the lung tissue. High pressures can cause alveolar over-distension and damage, known as barotrauma, which can exacerbate the condition of patients with ARDS, leading to further complications such as pneumothorax or worsening lung injury. By carefully monitoring and managing plateau pressure, healthcare providers can minimize the risk of barotrauma while ensuring adequate ventilation and oxygenation in these critically ill patients. In contrast, maximal inspiratory pressure primarily reflects muscle strength during inspiration and doesn’t directly correlate with lung injury risk. Mean airway pressure is influenced by various factors, including tidal volume and respiratory rate, but it may not provide the same direct insights into lung compliance as plateau pressure does. Lastly, dynamic compliance assesses the lung compliance during active breathing, which is important but not as directly conclusive