Peak pressure changes while plateau stays similar

A fictional ventilated adult has a new high peak-pressure alarm during an operation. Under the appropriate passive measurement conditions, the plateau pressure is similar to the earlier value. The tube, circuit, flow waveform, secretions and chest examination have not yet been fully checked. A trainee assumes that the lung has definitely become less compliant and proposes increasing every pressure limit without examining the system. The supervisor asks for the distinction between resistance and compliance before an action is chosen. The case supplies no automatic ventilator setting or instruction to ignore deterioration. It concerns interpreting the actual measurements, checking plausible causes and communicating what remains uncertain while the responsible team evaluates the patient and equipment.