From the Guidelines
The latest treatment guidelines for postoperative atelectasis prioritize lung-protective ventilation strategies, including the use of low tidal volumes and positive end-expiratory pressure (PEEP), to minimize lung injury and promote lung recruitment, as recommended by the international expert panel-based consensus recommendations published in the British Journal of Anaesthesia in 2019 1.
Key Interventions
The primary goal of these guidelines is to reduce the incidence of postoperative pulmonary complications, including atelectasis, by implementing evidence-based interventions, such as:
- Incentive spirometry every 1-2 hours while awake
- Deep breathing exercises
- Early ambulation within 24 hours of surgery when possible
- Adequate pain control to enable effective breathing
Additional Therapies
Chest physiotherapy with techniques such as percussion, vibration, and postural drainage may be beneficial for patients with significant secretions. Positive airway pressure therapies, including continuous positive airway pressure (CPAP) at 5-10 cmH2O or bilevel positive airway pressure (BiPAP) with inspiratory pressures of 10-15 cmH2O and expiratory pressures of 5 cmH2O, are recommended for patients with moderate to severe atelectasis.
Medications
Bronchodilators such as albuterol (2.5 mg via nebulizer every 4-6 hours) may help patients with bronchospasm. For patients with thick secretions, mucolytics like N-acetylcysteine or nebulized hypertonic saline (3-7%) can improve clearance.
Invasive Interventions
Fiberoptic bronchoscopy is reserved for cases with significant lobar collapse that doesn't respond to conservative measures. These interventions work by increasing lung volumes, improving mucociliary clearance, and reducing airway closure, which helps re-expand collapsed alveoli and improve ventilation-perfusion matching, as supported by the American College of Physicians guidelines published in the Annals of Internal Medicine in 2006 1.
From the FDA Drug Label
Acetylcysteine solution, USP is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as: ... Atelectasis due to mucous obstruction ... Pulmonary complications associated with surgery The latest treatment guidelines for post operative atelectasis may include the use of N-acetylcysteine as an adjuvant therapy to help manage abnormal mucous secretions, which can contribute to atelectasis, especially in cases where mucous obstruction is a factor, in the context of pulmonary complications associated with surgery 2.
- Key points:
- N-acetylcysteine is used for conditions with abnormal mucous secretions
- It is indicated for atelectasis due to mucous obstruction
- It can be used for pulmonary complications associated with surgery
From the Research
Treatment Guidelines for Postoperative Atelectasis
- The treatment of postoperative atelectasis varies depending on the duration and severity of the causal disease, ranging from chest physiotherapy to postural drainage, bronchodilator, and anti-inflammatory therapy 3.
- Prophylaxis includes preoperative and postoperative physiotherapy and medications, which should be graded in accordance with the individual patient's risk factors 4.
- Large atelectasis requires bronchoscopy to remove mucous plugs, and tracheostomy should be considered in patients with relapsing atelectasis or swallow disorders 4.
- Incentive spirometry alone is not recommended for routine use in the preoperative and postoperative setting to prevent postoperative pulmonary complications, but it may be used with deep breathing techniques, directed coughing, early mobilization, and optimal analgesia 5.
- Deep-breathing exercises have been shown to reduce atelectasis and improve pulmonary function after coronary artery bypass surgery 6.
Recommended Therapies
- Chest physiotherapy and postural drainage to help clear secretions from the lungs 3.
- Bronchodilator and anti-inflammatory therapy to help reduce airway obstruction and inflammation 3.
- Bronchoscopy to remove mucous plugs in cases of large atelectasis 4.
- Deep-breathing exercises, such as those performed with a positive expiratory pressure blow-bottle device, to improve pulmonary function and reduce atelectasis 6.