What is the treatment for atelectasis?

Treatment for Atelectasis

The primary treatment for atelectasis includes airway clearance techniques, breathing exercises, proper positioning, and in some cases bronchoscopy to remove mucus plugs causing persistent atelectasis. 1

Airway Clearance Techniques

• Chest physiotherapy including postural drainage, percussion, and vibration techniques should be implemented to mobilize secretions and promote airway clearance 1, 2
• The forced expiration technique (huffing) effectively increases airway clearance and should be taught to patients for self-management 2
• Suctioning may be necessary when cough is inadequate to clear secretions, but routine deep suctioning should be avoided as it may worsen lung volumes 1, 3
• For persistent mucus plugs causing atelectasis, flexible bronchoscopy should be performed for direct visualization and removal of obstructing secretions 1, 4

Breathing Exercises and Lung Expansion

• Incentive spirometry should be used to encourage deep breathing and maximal inspiration, helping prevent and treat atelectasis 1, 2
• Respiratory muscle strength training improves ventilatory patterns, lung volumes, and respiratory muscle strength 2
• Alveolar recruitment maneuvers involving transient elevation of airway pressures (30-40 cm H2O for 25-30 seconds) effectively re-expand collapsed lung tissue 1, 5
• Positive expiratory pressure (PEP) therapy opens airways while promoting removal of secretions 3

Positioning and Mobilization

• Patient positioning with head elevated at least 30 degrees improves lung expansion and helps prevent further atelectasis 1, 2
• Early mobilization and physical activity should be encouraged as immobility contributes to deterioration in lung function 1, 2
• In mechanically ventilated patients, optimize patient positioning to reduce atelectasis formation 1

Pharmacological Interventions

• For cases with fever (≥38.5°C) persisting for more than 3 days or with confirmed pneumonia/atelectasis on chest X-ray, appropriate antibiotic therapy should be initiated 6
• In children under 3 years, beta-lactams (amoxicillin, amoxicillin-clavulanate, cefuroxime-axetil, or cefpodoxime-proxetil) are recommended 6
• In children over 3 years, macrolides are appropriate if atypical bacteria are suspected 6

Mechanical Ventilation Strategies (If Applicable)

• Positive end-expiratory pressure (PEEP) helps maintain functional residual capacity but does not restore it; therefore, recruitment maneuvers should be performed before increasing PEEP 1
• PEEP should be individualized after recruitment maneuvers to avoid alveolar overdistention or collapse 1
• Consider continuous positive airway pressure (CPAP) immediately post-extubation, especially in obese patients 1
• Postoperative CPAP (7.5-10 cm H2O) reduces atelectasis, pneumonia, and reintubation rates after major abdominal surgery 1

Prevention Strategies

• Avoid high FiO2 (>0.8) during emergence from anesthesia as it significantly increases atelectasis formation 1, 7
• If clinically appropriate, use FiO2 <0.4 during emergence to reduce atelectasis 1, 8
• Avoid turning off the ventilator to allow CO2 accumulation before extubation as it causes alveolar collapse 1
• Avoid routine suctioning before extubation as it reduces lung volume 1

Special Considerations

• Obese patients develop larger atelectatic areas and may benefit more from CPAP immediately post-extubation 1
• In patients with pneumonia, atelectasis may be a complication requiring specific attention to prevent respiratory deterioration 6
• For patients with recurrent respiratory infections, consider evaluation for underlying causes such as gastroesophageal reflux disease or aspiration 3
• Cough assist devices may improve forced vital capacity and peak cough flow in patients with neuromuscular weakness contributing to atelectasis 3

Common Pitfalls to Avoid

• Applying PEEP without first performing recruitment maneuvers (PEEP maintains but does not restore functional residual capacity) 1
• Relying solely on supplemental oxygen without addressing the mechanical aspects of atelectasis 2
• Performing airway clearance techniques without proper instruction, which can reduce effectiveness 2
• Using high FiO2 during recovery which can worsen atelectasis formation 1, 8