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

From the Guidelines

Atelectasis treatment should prioritize the use of higher PEEP levels, as well as recruitment maneuvers (RMs), to reduce atelectasis and improve lung function, as evidenced by the most recent and highest quality study 1. The primary approach to treating atelectasis involves addressing the underlying cause and re-expanding collapsed lung tissue.

• Breathing exercises like deep breathing and incentive spirometry should be performed 10 times every hour while awake.
• Chest physiotherapy, including postural drainage and percussion, helps mobilize secretions.
• For mucus plugging, nebulized bronchodilators (albuterol 2.5mg every 4-6 hours) and mucolytics (N-acetylcysteine 600mg twice daily) may be prescribed.
• Supplemental oxygen should be provided to maintain oxygen saturation above 92%. In severe cases, continuous positive airway pressure (CPAP) at 5-10 cmH2O or bronchoscopy for mucus removal may be necessary, as supported by the evidence 1. Treating underlying conditions such as pneumonia requires appropriate antibiotics. Patients should be encouraged to ambulate early after surgery or illness to prevent atelectasis. These interventions work by increasing transpulmonary pressure, improving mucociliary clearance, and reducing airway resistance, which collectively help re-expand collapsed alveoli and restore normal lung function. The use of higher PEEP levels and RMs has been shown to be effective in reducing atelectasis and improving lung function, with a significant association with lower mortality and higher oxygenation 1.

From the FDA Drug Label

Acetylcysteine solution, USP is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as: ... Atelectasis due to mucous obstruction N-acetylcysteine (PO) can be used as adjuvant therapy for atelectasis treatment due to mucous obstruction 2.

• The drug is indicated for conditions with abnormal, viscid, or inspissated mucous secretions.
• Atelectasis is specifically mentioned as a condition that may be treated with this drug when caused by mucous obstruction.

From the Research

Treatment Options for Atelectasis

• Chest physiotherapy is a common treatment approach for atelectasis, as mentioned in 3 and 4.
• Postural drainage and bronchodilator therapy may also be used to treat atelectasis, as stated in 3.
• Bronchoscopy can be used to remove persistent mucous plugs, as noted in 3 and potentially useful in patients with mucous plugging of the airways, as mentioned in 4.
• Positive end-expiratory pressure (PEEP) might be a useful adjunct to treatment in passive and adhesive atelectasis, as suggested in 4.
• Recruitment maneuver with endobronchial blocker is a new treatment modality for unilateral atelectasis, as described in 5.
• Nasal continuous positive airway pressure (CPAP) has been used as an effective modality for therapy of pulmonary atelectasis in spontaneously breathing patients, as reported in 6.

Considerations for Treatment

• The treatment of atelectasis varies depending on the duration and severity of the causal disease, as mentioned in 3.
• The underlying cause of atelectasis should be considered when determining the treatment approach, as noted in 5.
• Atelectasis in the presence of preexisting lung disease or limited cardiopulmonary reserve may have significant consequences, as stated in 7.