What is the treatment for atelectasis (collapse of lung tissue)?

Management of Atelectasis

The most effective treatment for atelectasis includes deep breathing exercises, early mobilization, proper positioning, and non-invasive positive pressure ventilation when conservative measures fail. 1

Non-Invasive Interventions (First-Line)

Breathing Exercises and Mobilization

• Implement deep breathing exercises and incentive spirometry every 1-2 hours while awake 1
• Encourage early mobilization to improve ventilation 1
• Consider respiratory muscle strength training for patients with neuromuscular weakness 1

Proper Positioning

• Position patient with head of bed elevated 30 degrees (beach chair position) 1
• Avoid flat supine positioning as it worsens atelectasis 1
• Upright positioning reduces abdominal pressure on the diaphragm 1

Airway Clearance

• Teach airway clearance techniques (ACTs) to be performed once or twice daily by a trained respiratory physiotherapist 1
• Ensure adequate hydration to keep secretions thin

Advanced Interventions (When Conservative Measures Fail)

Non-Invasive Ventilation

• Apply CPAP or non-invasive positive pressure ventilation (NIPPV) if conservative measures fail to improve oxygenation 1, 2
• For post-operative patients, both bilevel NIV and CPAP have been shown to increase lung aeration and decrease atelectasis 2
• Consider alveolar recruitment maneuvers (ARMs) to reopen collapsed alveoli 2
  • Ventilator-driven ARMs are preferred over manual ARMs 2
  • Monitor hemodynamics closely during ARMs as they may cause transient instability 2

Bronchoscopy

• Consider bronchoscopy when atelectasis persists despite conservative measures 1
• Particularly useful for removing persistent mucous plugs 1, 3
• Provides direct visualization of airways and targeted removal of secretions 1

Prevention Strategies

Ventilation Management

• Maintain adequate PEEP (positive end-expiratory pressure) to prevent alveolar collapse 1, 4
  • Higher PEEP settings (10-15 cm H₂O) may be needed to recruit collapsed lung units 1
  • Even moderate PEEP (7-9 cm H₂O) can minimize atelectasis formation during surgery 4
• Avoid zero end-expiratory pressure (ZEEP) as it worsens atelectasis 1

Oxygen Management

• Use controlled oxygen therapy to maintain SpO₂ ≥94% 1
• Use lowest possible FiO₂ to achieve adequate oxygenation 1
• Avoid high FiO₂ (>0.8) during emergence from anesthesia as it increases atelectasis formation 1, 5

Post-Extubation Care

• Apply CPAP after extubation in high-risk patients to prevent atelectasis formation 1
• Avoid routine suctioning of the tracheal tube just before extubation 1

Special Considerations

Post-Operative Patients

• NIV has been shown to reduce the need for re-intubation and hospital mortality in patients who developed respiratory failure after lung cancer resection 2
• In patients with post-operative acute respiratory failure, NIV reduced the risk of tracheal re-intubation and healthcare-associated infections 2

Monitoring

• Monitor arterial blood gases to assess improvement in oxygenation 1
• Obtain follow-up chest radiographs to document resolution 1

Potential Complications if Untreated

• Persistent atelectasis can lead to pneumonia and hypercapnic respiratory failure 1
• Delayed treatment can worsen outcomes 1
• Overlooking fluid overload can contribute to ventilatory failure 1

By implementing these evidence-based interventions promptly and systematically, atelectasis can be effectively managed to improve patient outcomes and prevent complications.