What is the initial treatment for a patient with atelectasis?

From the Guidelines

The initial treatment for atelectasis should focus on addressing the underlying cause and re-expanding the collapsed lung tissue, with the use of noninvasive positive pressure ventilation (NIPPV) or continuous positive airway pressure (CPAP) being recommended for patients who are hypoxemic and at risk of developing acute respiratory failure, as suggested by the European Society for Anaesthesiology and Intensive Care and European Society of Intensive Care Medicine (ESA/ESICM) guidelines 1.

Key Interventions

• Encouraging deep breathing exercises, incentive spirometry, and early mobilization to help open collapsed airways
• Chest physiotherapy, including postural drainage and chest percussion, to help clear secretions
• Supplemental oxygen to maintain adequate oxygenation
• Bronchoscopy for patients with mucus plugging to remove obstructing secretions
• Drainage procedures for atelectasis due to external compression, such as pleural effusion or pneumothorax

Use of Positive Pressure Ventilation

• CPAP at 5-10 cmH2O or BiPAP may be used in more severe cases to maintain airway patency and recruit collapsed alveoli
• These interventions increase transpulmonary pressure, improve lung compliance, and facilitate secretion clearance, ultimately restoring normal ventilation to the affected lung segments and preventing complications like hypoxemia and pneumonia

Clinical Considerations

• Patients with obesity hypoventilation syndrome or obstructive sleep apnea may require additional considerations, such as the use of CPAP or BiPAP, to manage their condition and prevent postoperative pulmonary complications 1
• The use of NIPPV or CPAP should be done in a clinical area where staff are competent in the management of these therapies, and where clinical examination and continuous physiological monitoring plus frequent arterial blood gas sampling can occur 1

From the Research

Initial Treatment for Atelectasis

The initial treatment for a patient with atelectasis depends on the underlying cause and severity of the condition.

• Treatment options may include:
  • Chest physiotherapy
  • Postural drainage
  • Bronchodilator and anti-inflammatory therapy 2
  • Removal of persistent mucous plugs by bronchoscopy 2
  • Use of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) to help reopen collapsed lung tissue 3, 4, 5
• The use of CPAP has been shown to be effective in reexpanding atelectasis in some cases, particularly in patients with malignant atelectasis 4
• A ventilation strategy with a combination of CPAP or PEEP and a reduced end-expiratory oxygen concentration during recovery may also be beneficial in reducing post-operative atelectasis 5

Prevention of Atelectasis

Prevention of atelectasis is also an important consideration, particularly in patients undergoing general anesthesia or those with underlying lung disease.

• Techniques such as using positive end-expiratory pressure or a high tidal volume, or both in combination, may be used to prevent atelectasis or to reopen collapsed lung tissue 3
• Alveolar recruitment strategies have been tried in various settings, including bariatric surgery, single-lung ventilation, laparoscopy, and adult respiratory distress syndrome, and have been shown to reduce or prevent atelectasis 3