If the plateau pressure exceeds this value and there is no problem with the chest wall that could be contributing (eg, ascites, pleural effusion, acute abdomen, chest trauma), the physician should reduce the tidal volume in 0.5 - to 1.0-mL / kg increments as tolerated to a minimum of 4 mL / kg, raising the respiratory rate to compensate for the reduction in minute ventilation and inspecting the ventilator waveform display to ensure that full exhalation occurs.