A high plateau pressure during inspiratory hold indicates which of the following?

• A. Overdistension and risk of barotrauma; adjust tidal volume
• B. Normal lung compliance; no changes
• C. Airway obstruction only
• D. Low PEEP would fix

Answer: (A)

Plateau pressure during an inspiratory hold reflects the pressure in the alveoli when airflow is zero, so it mainly shows how distended the lungs are with the delivered tidal volume. A high plateau pressure means the lungs are being overexpanded, which raises the risk of barotrauma. The best action is to reduce the tidal volume (or otherwise adjust ventilation) to bring the plateau pressure down and protect the lungs.

Normal lung compliance wouldn’t produce a high plateau pressure, so that option doesn’t fit. Airway obstruction tends to elevate peak airway pressure from resistance, not the end-inspiratory plateau specifically. And lowering PEEP doesn’t directly fix a high plateau caused by overdistension from the tidal volume, since PEEP mainly affects end-expiratory pressure and recruitment, not the end-inspiratory alveolar pressure.