If a patient with ARDS has a plateau pressure greater than 30 cm H2o, what is the first step to take next?

In the context of a patient with Acute Respiratory Distress Syndrome (ARDS), a plateau pressure greater than 30 cm H2O is indicative of potential over-distension and can signal increased risk of lung injury. The recommended approach in this situation is to prioritize lung protective ventilation strategies.

Decreasing the tidal volume in increments allows for a reduction in plateau pressure while maintaining adequate ventilation. This helps prevent further injury to the patient's lungs by avoiding excessive volume that could exacerbate lung stress and strain. In ARDS management, lowering tidal volume is aligned with the principles of protecting the lung parenchyma, adhering to lower tidal volume protocols typically set at around 4 to 6 mL/kg of predicted body weight to improve patient outcomes.

The other options do not align with these protective strategies. For instance, increasing the tidal volume contradicts the goal of minimizing plateau pressures and can worsen lung compliance issues. Increasing the ventilator rate might help with minute ventilation but does not directly address the underlying problem of high plateau pressures. Changing to a non-invasive ventilator might be inappropriate if the airway support mechanism requires more control than would be afforded by non-invasive methods, especially in severe cases of ARDS.