Accueil
Even if the idea of a “safe” plateau pressure is already being questioned, it is still standard of care to use it for tailoring lung-protective ventilation in acute respiratory distress (ARDS) patients1. This gives rise to a common question asked by users of HAMILTON-C1/T1/MR1 ventilators: How can I measure/calculate Pplateau with my device?
Due to the valveless pneumatics in the HAMILTON-C1/T1/MR1 ventilators, it is not possible to obtain the Pplateau by performing an inspiratory hold maneuver.
Nevertheless, Pplateau is still available as a monitoring parameter:
| HAMILTON-C1/T1/MR1 SW < v2.2.0 | HAMILTON-C1/T1/MR1 SW > v2.2.0 |
|---|---|
| End-inspiratory pressure always displayed as Pplateau. Please consider that if an end-inspiratory flow is present, the Pplateau displayed is higher than the actual Pplateau. |
Pplateau is only displayed if the end-inspiratory flow is close to zero. The Pplateau displayed can still be higher than the actual Pplateau. |
A possible workaround for calculating Pplateau in situations where the end-inspiratory flow is not close to zero or the pressure measured end-inspiratory seems inaccurate:
- Calculate driving pressure
Driving pressure (
P) = VTE/Cstat
- Calculate Pplateau
Pplateau =P + PEEP
This calculation is dependent on an accurate Cstat measurement, which means there is no significant patient effort occurring. Pinsp should be at least ~10cmH20.
Example
VTE: 450ml; Cstat: 50 ml/cm; H20 PEEP: 8cmH20
Pplateau = 17 cmH2O
P = 9 cmH2O
Another benefit is that you get the P as a side product of your calculations. P is strongly associated with survival in ADRS patients and may therefore be the more interesting parameter2 .
Relevant devices: HAMILTON-C1/T1/MR1 (all software versions)
References:
- Loring, S. H. & Weiss, J. W. (2007). Plateau Pressures in the ARDSnet Protocol: Cause of Injury or Indication of Disease? American Journal of Respiratory and Critical Care Medicine, 176(1), 99b-100.
- Amato, M. B. P., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L. V., Schoenfeld, D. A., Stewart, T. E., Briel, M., Talmor, D., Mercat, A., Richard, J.-C. M., Carvalho, C. R. R., Brower, R. G. (2015). Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med, 372(8), 747-755.
Related Articles
Disclaimer:
The content of this Knowledge Base is intended for use by Hamilton Medical distribution partners for informational purposes only, and should not be copied, distributed or published in any way. While the information contained herein is believed to be accurate, it does not represent an official recommendation from Hamilton Medical AG, nor may it substitute an opinion, assessment or instructions provided by a trained healthcare professional.
