Advanced practice note
When airway pressure rises, separate resistance from compliance
Peak pressure is an alarm. Plateau pressure, flow, capnography, and the clinical picture turn it into a usable differential diagnosis.
A rising peak airway pressure is a signal to pause and localise the problem. The first distinction is whether the additional pressure is resistive or elastic. A widening gap between peak and plateau pressure suggests increased resistance in the circuit, tube, or airways. A rise in both points toward reduced respiratory-system compliance.
That distinction should immediately shape the bedside examination. Check tube depth and patency, circuit kinking, secretions, bronchospasm, surgical retraction, pneumoperitoneum, positioning, and the possibility of an evolving pleural process. Capnography, delivered volumes, auscultation, and the surgical field each narrow the possibilities differently.
The point is not to recite a list. It is to use the mechanics of ventilation to decide which branch of the list deserves attention first, while maintaining oxygenation and communicating clearly with the surgical team.