From the Guidelines
Atelectasis should be treated with higher levels of positive end-expiratory pressure (PEEP) to reduce lung stress and strain, and prevent atelectrauma, as evidenced by a conditional recommendation with moderate confidence in effect estimates 1.
Diagnosis of Atelectasis
Atelectasis is the collapse or closure of a lung or part of a lung, resulting in reduced or absent gas exchange. It occurs when the alveoli (air sacs) become deflated or filled with fluid. Diagnosis is typically made through chest radiography, computed tomography (CT) scans, or lung ultrasound.
Treatment of Atelectasis
Treatment depends on the cause and severity but typically includes:
- Addressing the underlying condition
- Encouraging deep breathing exercises
- Incentive spirometry
- Chest physiotherapy
- Early mobilization
- For significant atelectasis, bronchoscopy may be necessary to remove mucus plugs
- Supplemental oxygen is often provided to maintain adequate oxygenation
Prevention Strategies
Prevention strategies include:
- Encouraging deep breathing
- Coughing exercises
- Early ambulation after surgery
- Proper positioning
- Adequate pain control
Causes of Atelectasis
Atelectasis develops when airways become blocked or when pressure outside the lung causes it to collapse. Common causes include:
- Mucus plugs
- Foreign bodies
- Tumors
- Pleural effusions
- Pneumothorax
- Prolonged shallow breathing after surgery or during mechanical ventilation
Complications of Untreated Atelectasis
If left untreated, atelectasis can lead to:
- Hypoxemia
- Pneumonia
- Respiratory failure, particularly in patients with underlying lung disease or those who are critically ill, as supported by the findings of higher PEEP strategies in patients with moderate or severe acute respiratory distress syndrome (ARDS) 1.
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 Acetylcysteine may be introduced directly into a particular segment of the bronchopulmonary tree by inserting (under local anesthesia and direct vision) a small plastic catheter into the trachea.
The diagnosis of atelectasis is not explicitly stated in the provided drug labels. The treatment for atelectasis due to mucous obstruction is adjuvant therapy with N-acetylcysteine 2. The recommended dose and administration method may vary depending on the patient's condition and the equipment available, as described in the dosage and administration section of the drug label 2.
From the Research
Diagnosis of Atelectasis
- Atelectasis can be diagnosed using chest radiographs with both anterior-posterior and lateral projections 3
- Computed tomography can also be used to demonstrate atelectasis, but it may not be visible on conventional chest x-ray 4
- Diagnosis can be challenging, and differentiation from lobar consolidation may be a clinical dilemma 3
Causes of Atelectasis
- Atelectasis is mainly caused by three factors: compression, gas absorption, and lack of surfactant 5
- Compression and gas absorption are the two most commonly implicated factors 5
- Atelectasis can occur due to airway obstruction, compression of parenchyma, or increased surface tension in alveoli and bronchioli 3
Treatment of Atelectasis
- Treatment varies depending on the duration and severity of the causal disease 3
- Techniques to prevent or treat atelectasis include:
- Avoiding high fractions of oxygen in inspired gas during induction and maintenance of anesthesia may prevent formation of atelectasis 4
- Intermittent "vital capacity" maneuvers together with PEEP can reduce the amount of atelectasis and pulmonary shunt 4