From the Guidelines
Treatment for atelectasis should prioritize addressing the underlying cause and re-expanding collapsed lung tissue, with a focus on noninvasive positive pressure ventilation (NIPPV) or continuous positive airway pressure (CPAP) for patients at high risk of postoperative hypoxemia and pulmonary complications, as recommended by the European Society for Anaesthesiology and Intensive Care and European Society of Intensive Care Medicine (ESA/ESICM) 1. The approach to treating atelectasis depends on the severity and cause, but typically includes:
- Deep breathing exercises
- Incentive spirometry
- Chest physiotherapy
- Early mobilization
- For patients with significant mucus plugging, suctioning through a bronchoscope may be necessary to clear airways
- Positioning therapy, where patients are encouraged to change positions frequently or lie on their unaffected side, helps promote lung expansion
- Supplemental oxygen may be provided to maintain adequate blood oxygen levels, with a focus on using lower fractions of inspired oxygen (FiO2) during emergence to reduce atelectasis formation, if clinically appropriate 1
- In cases where atelectasis is caused by an obstruction like a foreign body or tumor, bronchoscopy or surgery might be required to remove the blockage
- Treating underlying conditions such as pneumonia with appropriate antibiotics is essential
- For severe cases, CPAP or mechanical ventilation may be necessary Prevention strategies include encouraging deep breathing, early ambulation after surgery, adequate pain control, and avoiding prolonged bed rest when possible. It is also important to note that lung-protective ventilation strategies, such as avoiding derecruitment and over-distension of alveoli, can help reduce postoperative pulmonary complications 1. Overall, the goal of treatment is to improve oxygenation, reduce the risk of pulmonary complications, and promote lung expansion, with a focus on evidence-based recommendations from recent and high-quality studies 1.
From the Research
Treatment Options for Atelectasis
The treatment for atelectasis varies depending on the duration and severity of the causal disease. Some of the treatment options include:
- Chest physiotherapy 2
- Postural drainage 2
- Bronchodilator and anti-inflammatory therapy 2
- Removal of persistent mucous plugs by bronchoscopy 2
- Incentive spirometry, which has been shown to be effective in reducing the incidence of atelectasis in children undergoing cardiac surgery 3
- Continuous positive airway pressure (CPAP) via mask therapy, which has been found to be effective in treating or preventing post-surgical atelectasis, particularly in smokers and elderly patients 4
- Protective ventilatory strategy, which includes the use of low tidal volumes, plateau pressures, and positive end-expiratory pressure (PEEP) to mitigate lung injury and prevent postoperative pulmonary complications 5
Specific Treatment Approaches
Different studies have investigated the effectiveness of various treatment approaches for atelectasis, including:
- The use of CPAP via mask therapy every 2 hours, which has been found to be more effective than incentive spirometry or CPAP via mask therapy every 4 hours in improving inspiratory capacity and oxygen saturation 4
- The adoption of an "open lung" philosophy, which involves the use of protective ventilatory strategies and early mobilization, breathing exercises, and continuous positive airway pressure to maintain lung aeration and reduce the risk of postoperative pneumonia 5