From the Guidelines
Treatment for atelectasis of the lung should prioritize the use of higher PEEP levels, as it has been shown to reduce atelectasis and improve lung recruitment in patients with moderate or severe ARDS 1.
Overview of Atelectasis Treatment
Atelectasis treatment aims to re-expand the collapsed lung tissue, improve airflow, and address underlying causes. The approach can vary depending on the severity and cause of atelectasis.
Conservative Measures
Initial treatment includes conservative measures such as:
- Deep breathing exercises (10 deep breaths every hour while awake)
- Frequent position changes, especially sitting upright and leaning slightly forward
- Use of an incentive spirometer (aiming for 10 repetitions every 1-2 hours)
- Chest physiotherapy, including percussion and postural drainage, to clear secretions
Pharmacological Interventions
For persistent cases, pharmacological interventions may be considered:
- Bronchodilators like albuterol (2 puffs every 4-6 hours as needed) to open airways
- Mucolytics like N-acetylcysteine to thin secretions
Advanced Therapies
In more severe cases, advanced therapies such as:
- CPAP (Continuous Positive Airway Pressure) therapy
- Bronchoscopy may be necessary to increase lung volume, improve gas exchange, and remove obstructions.
Importance of Addressing Underlying Conditions
It is crucial to treat any underlying conditions causing the atelectasis, such as pneumonia or tumors. If symptoms worsen, such as severe shortness of breath, immediate medical attention is necessary.
Evidence-Based Recommendation
The use of higher PEEP levels is supported by the American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline, which suggests that adult patients with moderate or severe ARDS receive higher rather than lower levels of PEEP 1. This approach can help reduce atelectasis and improve lung recruitment, ultimately leading to better patient outcomes in terms of morbidity, mortality, and quality of life.
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 The treatment for atelectasis of the lung due to mucous obstruction is adjuvant therapy with N-acetylcysteine (PO) 2.
- Key points:
- N-acetylcysteine is used as an adjuvant therapy
- It is used for atelectasis due to mucous obstruction
- The drug is used for its mucolytic properties to help clear abnormal mucous secretions 2
From the Research
Treatment Options for Atelectasis of the Lung
The treatment of atelectasis depends on the underlying cause and can vary depending on the duration and severity of the condition. Some of the treatment options include:
- Chest physiotherapy to help clear mucus from the airways 3, 4
- Postural drainage to help loosen and clear mucus from the lungs 3
- Bronchodilator and anti-inflammatory therapy to help open up the airways and reduce inflammation 3
- Bronchoscopy to remove persistent mucus plugs or other obstructions from the airways 3, 4, 5, 6
- Selective left bronchial aspiration (SeLBA) for left lung atelectases, which involves using a double catheter suctioning technique to clear away secretions 5
- Recruitment maneuver with endobronchial blocker, which can be used to treat unilateral atelectasis 7
- Oxygen therapy and, in some cases, reintubation may be necessary to support the patient's breathing 4
Removal of Mucus Plugs
Mucus plugs can be a major cause of atelectasis, and their removal is crucial for treating the condition. This can be done through:
- Bronchoscopy, which allows for the direct visualization and removal of mucus plugs 3, 4, 5, 6
- Bronchoscopic aspiration and lavage, which involves the use of saline instillation and suctioning to remove retained secretions or mucus plugs 4
- Double catheter suctioning technique, such as SeLBA, which can be used to clear away secretions from the left lung 5