This ARDS patient is ventilated using Adaptive Support Ventilation (ASV®) with PEEP set at 16 cmH2O. There is an alarm associated with the message "Pressure limitation". What does the alarm mean and how can you correct it?
Answer: The Plimit – the maximum peak pressure to be delivered in ASV mode - is too low.
Ppeak has reached the Plimit; therefore, the target VT calculated by the ASV algorithm can’t be achieved. As the target minute volume set by the clinician is not achieved, ASV increases the respiratory rate up to a certain point. To correct the problem, the clinician should accept a larger pressure difference between PEEP and the Plimit. This can be done by decreasing PEEP or by increasing the Plimit.
In either case, plateau pressure (Pplat) and driving pressure (DP) must be measured in order to ensure lung-protective ventilation (Pplat < 30cmH2O, DP < 15 cmH2O).
When using ASV, the clinician should set the Plimit higher than Ppeak. This ensures that ASV can still achieve the target VT even in the case of a sudden decrease in compliance (nursing procedure) or an increase in resistance (tube obstruction).
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