What should be maintained at less than 30 cmH2O in ARDS patients?

In patients with Acute Respiratory Distress Syndrome (ARDS), maintaining plateau pressure at less than 30 cmH2O is crucial for lung protection. Plateau pressure is the pressure applied to the small airways and alveoli during a static pause in mechanical ventilation. It provides an estimate of lung compliance and reflects the pressure required to inflate the lung against its resistance.

Limiting plateau pressure helps prevent ventilator-induced lung injury, which can occur when excessive pressure is applied to already compromised lung tissue. When plateau pressures exceed this threshold, it increases the risk of barotrauma and further damage to the alveoli, leading to worsening oxygenation and compliance.

In the context of the other options, while maintaining appropriate respiratory rates, PEEP levels, and tidal volumes are also important in the management of ARDS, they don't specifically hold the same critical threshold as plateau pressure. Therefore, ensuring that plateau pressure remains under 30 cmH2O is a key component in mechanical ventilation strategies for ARDS patients to minimize lung injury and optimize outcomes.