Limitation of plateau pressure (Pplateau) is critical for pro-tection from ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS).

Limiting to a 30 cmH2O threshold is a widely accepted recommendation for lung protection, in addition to the use of low tidal volume (VT) and positive end-expiratory positive pressure (PEEP).

Moreover, Pplateau is in of itself a powerful determinant of mortality in the general ARDS patient population, as well as being a compo-nent of other parameters associated with the risk of ven-tilator-induced lung injury and/or the clinical prognosis of ARDS patients, such as driving pressure or mechanical power.

In this short piece, we will discuss two conditions in which allowing a Pplateau above 30 cmH2O may be advis-able in ARDS patients.

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