What is the treatment for atelectasis?

Treatment of Atelectasis

The most effective treatment for atelectasis includes early mobilization, deep breathing exercises, incentive spirometry, and bronchoscopy for mucus plug removal in cases that don't respond to conservative measures. 1

First-Line Treatments

Respiratory Techniques

• Deep breathing exercises: Instruct patients to perform deep breathing exercises every 1-2 hours while awake to increase inspiratory volume 1
• Incentive spirometry: Teach patients to use incentive spirometry with 10 breaths every hour while awake to improve lung function 1
• Early mobilization: Start ambulation as soon as possible after surgery and progress gradually from sitting to walking 1
• Patient positioning: Position the patient with the head of bed elevated 30 degrees (beach chair position) to optimize lung expansion 1

Airway Clearance

• Airway clearance techniques (ACTs): Should be performed once or twice daily by a trained respiratory physiotherapist 1
• Adequate hydration: Ensure proper fluid intake to thin secretions and make them easier to clear 1
• Humidification: Consider humidifying inspired air to help loosen thick secretions 1

Second-Line Interventions

Ventilatory Support

• Recruitment maneuvers: Transient elevations in airway pressure (30-40 cmH₂O) can open collapsed lung and increase alveolar units participating in ventilation 1
• Non-invasive ventilation (NIV) or CPAP: Use if conservative measures don't improve oxygenation, with CPAP levels of 7.5-10 cmH₂O 1
• Controlled oxygen therapy: Maintain SpO₂ ≥94% with the lowest possible FiO₂, avoiding high FiO₂ (>0.8) during emergence from anesthesia 1

Invasive Procedures

• Flexible bronchoscopy: Used to restore airway patency by removing mucus plugs or blood clots causing atelectasis 1, 2
• Thoracocentesis: Consider ultrasound-guided thoracocentesis for significant (>400 mL) or symptomatic pleural effusions that may be contributing to atelectasis 1

Pain Management

• Locoregional analgesia: Use techniques such as paravertebral block, preferred over epidural analgesia due to better safety profile 1
• Anti-inflammatory medications: Short courses of NSAIDs in the postoperative period 1
• Patient-controlled analgesia (PCA): Consider with opioids after failure of locoregional analgesia techniques 1

Prevention Strategies

• Avoid high oxygen concentrations: While pre-oxygenation with FiO₂ of 1.0 is recommended before extubation to maximize oxygen stores 3, prolonged use of high oxygen concentrations during anesthesia maintenance can promote atelectasis formation 4, 5
• Alveolar recruitment before extubation: Although alveolar recruitment maneuvers may temporarily reverse atelectasis, they haven't shown benefit in the post-operative period 3
• Vaccination: Administer influenza and pneumococcal vaccines for patients with chronic conditions 1

Special Considerations

For Obese Patients

• Head-up tilt is especially useful as it provides mechanical advantage to respiration 3
• More aggressive recruitment maneuvers may be needed as these patients develop larger atelectatic areas 5

For Postoperative Patients

• Implement Enhanced Recovery After Surgery (ERAS) protocols that include early mobilization 1
• Use digital chest drainage systems for suction to improve management of pleural effusion 1
• Remove chest drains when no air leaks are observed and pleural drainage is <300 mL/day 1

Monitoring Response to Treatment

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

Potential Complications of Untreated Atelectasis

• Persistent atelectasis
• Pneumonia
• Hypercapnic respiratory failure 1

Common Pitfalls to Avoid

• Delayed treatment: Can lead to persistent atelectasis and complications 1
• Overuse of high oxygen concentrations: Can promote reappearance of atelectasis after recruitment 4, 5
• Inadequate pain control: Can prevent effective deep breathing and coughing
• Failure to recognize mucus plugs: May require bronchoscopy rather than continuing ineffective conservative measures 2