What is the treatment for atelectasis?

From the Guidelines

Treatment for atelectasis should focus on addressing the underlying cause and re-expanding collapsed lung tissue through deep breathing exercises, incentive spirometry, and chest physiotherapy, as recommended by the American College of Physicians 1. The primary approach includes encouraging patients to perform 10 deep breaths using an incentive spirometer every hour while awake, along with positional changes such as sitting upright and moving regularly to help mobilize secretions. For mucus plugging, treatments include adequate hydration (2-3 liters daily), mucolytics like N-acetylcysteine, and possibly bronchoscopy for severe cases to physically remove secretions, as supported by the concept of reducing postoperative pulmonary complications through selective use of procedures like nasogastric tubes 1. Supplemental oxygen may be needed to maintain adequate blood oxygen levels, and if atelectasis is caused by external compression, treating the underlying condition (such as pleural effusion or pneumothorax) is essential. Antibiotics are only indicated if a concurrent infection is present. For post-surgical patients, early mobilization and pain control are crucial to enable effective deep breathing, as highlighted in the context of reducing postoperative pulmonary risk through improved perioperative oxygenation and respiratory mechanics 1. These interventions work by increasing transpulmonary pressure, improving airflow to collapsed areas, and facilitating mucus clearance, which collectively help re-expand collapsed alveoli and restore normal lung function. Key considerations include avoiding over-distension of alveoli and reducing oxidative stress, inflammatory response, and lung injury, as emphasized in the discussion on lung-protective ventilation for surgical patients 1. Overall, the goal is to minimize morbidity, mortality, and impact on quality of life by effectively managing atelectasis and its underlying causes. Some of the key points to consider in the management of atelectasis include:

• Deep breathing exercises and incentive spirometry to encourage full lung expansion
• Positional changes and chest physiotherapy to mobilize secretions
• Adequate hydration and mucolytics for mucus plugging
• Supplemental oxygen as needed
• Treatment of underlying conditions causing external compression
• Antibiotics only for concurrent infections
• Early mobilization and pain control for post-surgical patients.

From the FDA Drug Label

Acetylcysteine 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 due to mucous obstruction is acetylcysteine as an adjuvant therapy.
• The recommended dose for most patients is 3 to 5 mL of the 20% solution or 6 to 10 mL of the 10% solution 3 to 4 times a day when nebulized into a face mask, mouth piece, or tracheostomy 2.
• Administration for intermittent or continuous prolonged periods, including overnight, may be desirable 2.

From the Research

Treatment 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
• Postural drainage
• Bronchodilator and anti-inflammatory therapy 3
• Removal of persistent mucous plugs by bronchoscopy 3
• Rigid ventilation bronchoscopy under general anesthesia for removal of mucus plugs or foreign bodies in pediatric patients 4
• Incentive spirometry to prevent postoperative complications in pediatric population 5

Specific Treatment Approaches

Different studies have investigated various treatment approaches for atelectasis, including:

• The use of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) and reduced end-expiratory oxygen concentration during recovery to reduce post-operative atelectasis 6
• The effectiveness of rigid ventilation bronchoscopy in treating pediatric pulmonary atelectasis caused by pneumonia 4
• The use of incentive spirometry in reducing the incidence of atelectasis in children undergoing cardiac surgery 5
• The impact of perioperative high inspired oxygen fraction on postoperative atelectasis in patients undergoing abdominal surgery 7

Treatment Outcomes

The outcomes of these treatment approaches have been studied, with results showing:

• Significant improvement in oxygen saturation or chest radiography within 72 hours in pediatric patients treated with rigid ventilation bronchoscopy 4
• Reduced incidence of atelectasis in children undergoing cardiac surgery who used incentive spirometry 5
• Lower scores of lung ultrasonography and incidence of significant atelectasis in patients who received low inspired oxygen fraction during anesthesia and recovery 7