From the Guidelines
Atelectasis itself is rarely a direct cause of death, but it can lead to fatal complications if severe or left untreated, with the most recent evidence suggesting that higher PEEP strategies can reduce atelectasis and improve outcomes in patients with moderate or severe ARDS 1.
Causes of Death from Lung Atelectasis
Death from lung atelectasis typically occurs due to respiratory failure, which happens when collapsed lung tissue prevents adequate oxygen exchange. This can progress to hypoxemia (low blood oxygen) and eventually hypoxic respiratory failure.
- Pneumonia is another serious complication, as bacteria can multiply in the stagnant secretions of collapsed lung segments, leading to infection that may become systemic and cause sepsis.
- Atelectasis can also worsen existing lung conditions like COPD or pulmonary fibrosis, potentially triggering acute exacerbations.
- In post-surgical patients, atelectasis increases the risk of ventilator-associated pneumonia and prolonged mechanical ventilation, which carry their own mortality risks.
Treatment and Prevention
Treatment focuses on addressing the underlying cause, which may include:
- Removing airway obstructions
- Chest physiotherapy
- Incentive spirometry
- Bronchoscopy for mucus plugs
- Positive pressure ventilation
- Early mobilization, deep breathing exercises, and adequate pain control are essential preventive measures, especially after surgery, as individualised PEEP can prevent progressive alveolar collapse and recruitment manoeuvres can reverse alveolar collapse, but have limited benefit without sufficient PEEP 1. Prompt treatment of atelectasis is crucial to prevent these potentially fatal complications, and the use of higher PEEP strategies, as recommended by the American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline, can improve outcomes in patients with moderate or severe ARDS 1.
From the Research
Causes of Death from Lung Atelectasis
The provided studies do not directly address the causes of death from lung atelectasis. However, they discuss the pathophysiology and treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), which can be related to lung atelectasis.
- Lung atelectasis can be a complication of ALI/ARDS, which can originate from direct lung triggers such as pneumonia or aspiration, or from extrapulmonary reasons such as sepsis or trauma 2, 3.
- The pathophysiology of ALI/ARDS involves increased alveolar epithelial endothelial permeability, flooding of alveoli, and reduced lung compliance, which can lead to respiratory failure and hypoxemia 3, 4.
- The treatment of ALI/ARDS is mainly supportive, with mechanical ventilation using a lung-protective strategy being the only proven treatment to improve survival 3, 5.
- Despite advancements in treatment, mortality from ALI/ARDS can still exceed 50%, with survivors having a good prognosis for recovery of lung function 3.
- Current research is focused on identifying novel treatment approaches and improving outcomes for ALI/ARDS, including the use of rescue therapies such as prone positioning and extracorporeal membrane oxygenation 4, 5.
Related Conditions
Lung atelectasis can be associated with various conditions, including: