From the Guidelines
Atelectasis after pneumonia in an 8-year-old male is primarily caused by airway obstruction from mucus plugging and inflammation, as well as potential complications such as lung abscess or empyema, or underlying host conditions like immunosuppression or coexistent disease. When a child has pneumonia, the infection leads to increased mucus production and inflammatory exudate that can block small airways, preventing air from reaching distal alveoli and causing them to collapse (atelectasis) 1. The British Thoracic Society guidelines for the management of community-acquired pneumonia in childhood suggest that if a child remains pyrexial or unwell 48 hours after admission, re-evaluation is necessary to identify potential complications or underlying conditions that may be contributing to the development of atelectasis 1.
Some key factors to consider in the development of atelectasis in this context include:
- Airway obstruction from mucus plugging and inflammation
- Potential lung complications such as pleural fluid collection, empyema, or lung abscess
- Underlying host conditions like immunosuppression or coexistent disease, such as cystic fibrosis
- Inadequate treatment or response to treatment, including inappropriate drug treatment or inadequate dosage
Treatment of atelectasis in this context typically involves addressing the underlying pneumonia with appropriate antibiotics, as well as supportive respiratory care, including:
- Encouraging deep breathing exercises and using incentive spirometry appropriate for the child's age
- Chest physiotherapy to mobilize secretions
- Adequate pain control to enable deep breathing
- Proper hydration to keep secretions thin and more easily cleared
- Potential bronchoscopy to remove mucus plugs in severe cases 1.
From the Research
Causes of Atelectasis
- Airway obstruction: Atelectasis may occur due to airway obstruction, which can be caused by mucus plugs or secretions that occlude the bronchial trees 2.
- Compression of parenchyma: Compression of lung parenchyma by extrathoracic, intrathoracic, or chest wall processes can also lead to atelectasis 2.
- Increased surface tension: Increased surface tension in alveoli and bronchioli can cause atelectasis 2.
- Resorption atelectasis: This type of atelectasis is caused by resorption of alveolar air distal to obstructing lesions of the airways 3.
- Adhesive atelectasis: This type of atelectasis stems from surfactant deficiency 3.
- Passive atelectasis: This type of atelectasis is caused by simple pneumothorax, diaphragmatic dysfunction, or hypoventilation 3.
- Compressive atelectasis: This type of atelectasis is due to tension pneumothorax, space-occupying intrathoracic lesions, or abdominal distention 3.
- Cicatrization atelectasis: This type of atelectasis stems from pulmonary fibrosis 3.
- Gravity-dependent atelectasis: This type of atelectasis is the result of gravity-dependent alterations in alveolar volume 3.
Mechanisms of Atelectasis in Pneumonia
- Mucus plugs or secretions: If mucus plugs or secretions occlude the bronchial trees and cannot be cleaned by coughing, suctioning, or vigorous respiratory and physical therapy, it can lead to atelectasis 4.
- Aspiration: Aspiration secondary to dysphagia and eosinophilic esophagitis can also lead to respiratory failure and atelectasis 5.
Treatment of Atelectasis
- Rigid ventilation bronchoscopy: Rigid ventilation bronchoscopy (V-B) under general anesthesia can be an effective and safe procedure to remove mucus plugs and restore pulmonary function in pediatric patients with atelectasis caused by pneumonia 4.
- Physiotherapy: Physiotherapy sessions using techniques such as Insufflation Technique to Reverse Atelectasis (ITRA) can be effective in reversing atelectasis 6.
- Positive end-expiratory pressure: The use of positive end-expiratory pressure (PEEP) can help in reversing atelectasis 6.