{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:19:27Z","timestamp":1788229167758,"version":"build-2803163510"},"reference-count":3,"publisher":"AACN Publishing","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In patients receiving pressure modes of mechanical ventilation, plateau pressure can be higher than peak inspiratory pressure when the patient has a strong drive to breathe. This report provides comprehensive evidence to support this observation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Peak inspiratory pressure, plateau pressure, esophageal pressure, and tidal volume were observed at various levels of pressure support in a patient with absent cortical function but preserved brainstem function who was receiving mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Positive end-expiratory pressure was 5 cm H2O for all pressure support settings. At pressure support of 0 cm H2O, plateau pressure was 13 cm H2O; peak inspiratory pressure was 5 cm H2O. The difference between plateau pressure and peak inspiratory pressure (8 cm H2O) reflected the patient\u2019s inspiratory effort. The driving pressure (8 cm H2O) generated a tidal volume of 619 mL. At pressure support of 10 cm H2O, plateau pressure was 12 cm H2O; peak inspiratory pressure was 15 cm H2O. The difference between plateau pressure and peak inspiratory pressure was \u20133 cm H2O, indicating absent inspiratory effort apart from triggering the breath. The driving pressure (7 cm H2O) generated a tidal volume of 563 mL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>When plateau pressure can be accurately measured, the difference between plateau pressure and peak inspiratory pressure can be used at the bedside to evaluate a patient\u2019s respiratory drive. Ensuring protective goals by routinely monitoring plateau pressure regardless of the mode of mechanical ventilation is critical.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4037\/ajcc2026219","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:02:25Z","timestamp":1788228145000},"page":"389-394","source":"Crossref","is-referenced-by-count":0,"title":["Plateau Pressure Exceeding Peak Inspiratory Pressure During Pressure Mode Ventilation With Active Inspiratory Effort"],"prefix":"10.4037","volume":"35","author":[{"given":"Hassan","family":"Sajjad","sequence":"first","affiliation":[{"name":"Hassan Sajjad is associate chief medical officer, Division of Pulmonary and Critical Care Medicine, Atlantic Health System, Hackettstown, New Jersey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Steffes","sequence":"additional","affiliation":[{"name":"Tracy Steffes is a nurse practitioner, Division of Cardiothoracic Surgery, University of Wisconsin\u2013Madison."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Haen","sequence":"additional","affiliation":[{"name":"Samuel Haen is a respiratory therapy supervisor, Respiratory Therapy Department, UW Health, Madison, Wisconsin."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold","family":"Winnike","sequence":"additional","affiliation":[{"name":"Harold Winnike is a respiratory therapist, Institute for Clinical and Translational Science, University of Iowa, Iowa City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Daniel P. McCarthy is an an associate professor of surgery, section chief of thoracic surgery, and surgical director of the lung transplant program, Division of Cardiothoracic Surgery, University of Wisconsin\u2013Madison."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Faust","sequence":"additional","affiliation":[{"name":"Hilary Faust is an assistant professor of medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin\u2013Madison."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Eberlein","sequence":"additional","affiliation":[{"name":"Michael Eberlein is a professor of medicine and medical director of the advanced pulmonary service, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin\u2013Madison."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"issue":"6","key":"2026083122021821100_b1-0350389","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1513\/AnnalsATS.201707-553CC","article-title":"Can the plateau be higher than the peak pressure?","volume":"15","author":"Sajjad","year":"2018","journal-title":"Ann Am Thorac Soc"},{"issue":"3","key":"2026083122021821100_b2-0350389","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1097\/CCM.0000000000004746","article-title":"Direction and magnitude of change in plateau from peak pressure during inspiratory holds can identify the degree of spontaneous effort and elastic workload in ventilated patients","volume":"49","author":"Kyogoku","year":"2021","journal-title":"Crit Care Med"},{"issue":"1","key":"2026083122021821100_b3-0350389","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1097\/MCC.0000000000000691","article-title":"Patient self-inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathing","volume":"26","author":"Yoshida","year":"2020","journal-title":"Curr Opin Crit Care"}],"container-title":["American Journal of Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aacnjournals.org\/ajcconline\/article-pdf\/35\/5\/389\/171784\/389.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aacnjournals.org\/ajcconline\/article-pdf\/35\/5\/389\/171784\/389.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:02:26Z","timestamp":1788228146000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacnjournals.org\/ajcconline\/article\/35\/5\/389\/33131\/Plateau-Pressure-Exceeding-Peak-Inspiratory"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":3,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.4037\/ajcc2026219","relation":{},"ISSN":["1062-3264","1937-710X"],"issn-type":[{"value":"1062-3264","type":"print"},{"value":"1937-710X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}