What is the treatment for atelectasis?

Treatment of Atelectasis

The treatment of atelectasis should include airway clearance techniques (ACTs) performed once or twice daily by a trained respiratory physiotherapist, deep breathing exercises, incentive spirometry every 1-2 hours while awake, early mobilization, and positioning with the head of the bed elevated 30 degrees to optimize lung expansion. 1

Non-Pharmacological Interventions

Positioning and Mobilization

• Position patient with head of bed elevated 30 degrees (beach chair position) to reduce abdominal pressure on the diaphragm 1
• Avoid flat supine positioning as it worsens atelectasis 1
• Encourage early active or passive mobilization to improve ventilation 1

Breathing Exercises and Airway Clearance

• Implement deep breathing exercises every 1-2 hours while awake 1
• Use incentive spirometry regularly during waking hours 1
• Apply airway clearance techniques taught by respiratory physiotherapists 1

Pharmacological Management

• N-acetylcysteine is indicated as adjuvant therapy for atelectasis due to mucous obstruction 2
• This mucolytic agent helps thin viscid secretions, facilitating their clearance

Advanced Interventions for Persistent Atelectasis

Positive Pressure Ventilation

• Apply CPAP (continuous positive airway pressure) or NIPPV (non-invasive positive pressure ventilation) if conservative measures fail 1
• Maintain adequate PEEP (positive end-expiratory pressure) to prevent alveolar collapse, with higher PEEP settings (10-15 cm H₂O) potentially needed to recruit collapsed lung units 1
• Avoid zero end-expiratory pressure (ZEEP) as it worsens atelectasis 1

Bronchoscopy

• Consider bronchoscopy when atelectasis persists despite conservative measures 1
• Particularly useful for removing persistent mucous plugs and direct visualization of airways 1
• Persistent mucous plugs should be removed by bronchoscopy if other measures fail 3

Prevention of Atelectasis

During Anesthesia and Post-Operative Care

• Use lower FiO₂ during emergence from anesthesia (FiO₂ <0.4) to reduce atelectasis formation 1
• Apply CPAP after extubation in high-risk patients to prevent atelectasis formation 1
• Employ lung-protective ventilation strategies in surgical patients, particularly those undergoing bariatric procedures 1

Alveolar Recruitment Strategies

• Alveolar recruitment maneuvers (vital capacity maneuver) can re-expand collapsed lung tissue 4
• After recruitment, ventilation with moderate FiO₂ (0.3-0.4) prevents rapid reappearance of atelectasis 4

Special Considerations

Monitoring and Follow-up

• Monitor arterial blood gases to assess improvement in oxygenation 1
• Obtain follow-up chest radiographs to document resolution 1
• Administer controlled oxygen therapy to maintain SpO₂ 94% or above 1

Pitfalls to Avoid

• Delaying treatment can lead to persistent atelectasis, pneumonia, and hypercapnic respiratory failure 1
• Overlooking fluid overload, which commonly contributes to ventilatory failure 1
• Using high FiO₂ (>0.8) during emergence from anesthesia increases atelectasis formation 1
• Routine suctioning of the tracheal tube just before extubation should be avoided to prevent atelectasis formation 1

The management approach should be escalated progressively from non-invasive techniques to more invasive interventions if the atelectasis persists, with careful monitoring of response to treatment throughout.