PT - JOURNAL ARTICLE AU - Ming-Cheng Chan AU - Jeng-Sen Tseng AU - Jung-Te Chiu AU - Kuo-Hsuan Hsu AU - Sou-Jen Shih AU - Chi-Yuan Yi AU - Chieh-Liang Wu AU - Yu Ru Kou TI - Prognostic Value of Plateau Pressure Below 30 cm H<sub>2</sub>O in Septic Subjects With Acute Respiratory Failure AID - 10.4187/respcare.03138 DP - 2015 Jan 01 TA - Respiratory Care PG - 12--20 VI - 60 IP - 1 4099 - http://rc.rcjournal.com/content/60/1/12.short 4100 - http://rc.rcjournal.com/content/60/1/12.full AB - BACKGROUND: Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (Pplat) to &lt; 30 cm H2O for septic patients needing mechanical ventilation. The aim of this study was to determine whether Pplat within the first 24 h of ICU admission is predictive of outcome and whether Pplat &lt; 30 cm H2O is associated with lower mortality rates. METHODS: This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009. RESULTS: There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 ± 6.5. Pneumonia was the major cause of sepsis (85.5%). The hospital mortality rate was 39.1%. Pplat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher Pplat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, Pplat &gt; 25 cm H2O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95% CI 1.10–4.91, P = .03 for hospital mortality). CONCLUSIONS: Pplat within the first 24 h of ICU admission is predictive of outcome, with lower Pplat associated with lower mortality rates. There is no safety margin for Pplat. Limiting Pplat should be considered even at &lt; 30 cm H2O in septic patients with acute respiratory failure.