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Dimens Crit Care Nurs. 2015 Jan-Feb;34(1):19-23. doi: 10.1097/DCC.0000000000000093.

Differential diagnosis of high peak airway pressures.

Author information

Tessa Covert, MSN, AGACNP-BC, CRNP, CCRN, has 10 years of nursing experience. She recently received her Master's of Science in Nursing from the University of Pennsylvania and currently works in the Medical ICU at Penn Presbyterian Hospital. Ng Tung Niu, MSN, CRNP, AGACNP-BC, CCRN, has 7 years of experience as an ICU RN. He recently graduated from the University of Pennsylvania and is now a CRNP at the University of Pennsylvania Trauma Critical Care Unit.



The sickest patients often require mechanical ventilation. Although mechanical ventilation is often a lifesaving intervention for many, it can also have life-threatening complications. Monitoring a patient on mechanical ventilation requires skill and prompt troubleshooting to ensure its proper function. The high peak airway pressure (HPAP) alarm is one of the most common alarms. It is critically important that clinicians understand the pathophysiology of the lung and the various causes behind the alarm and have a working differential diagnosis for the causes of HPAPs. The differential diagnosis for HPAP is extensive but can be managed quickly and effectively if you follow a systematic approach.


In this article, we aim to describe the basics of respiratory mechanics that contribute to HPAP alarms and describe concepts such as airway resistance, lung compliance, peak airway pressures, and plateau pressures. This is followed by a systematic approach to diagnosing the cause of the HPAP alarm.


The list of probable causes of HPAP is extensive. Many causes may be overlooked when there is not a clear understanding of its meaning and potential danger. Providing this algorithm gives relevance and importance to understanding the HPAP alarm and provides essential information for troubleshooting potentially dangerous situations.

[Indexed for MEDLINE]

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