From the Guidelines
The signs of atelectasis include decreased breath sounds over the affected area, dullness to percussion, tracheal deviation toward the affected side, and decreased chest wall movement, as well as dyspnea, tachypnea, cough, and in severe cases, cyanosis, as supported by the latest evidence from 1 and 1.
Key Findings
- Atelectasis occurs in roughly 90% of all patients undergoing general anaesthesia and can persist for weeks after operation, as stated in 1.
- The condition reduces gas exchange capacity and can lead to hypoxemia, emphasizing the need for prompt diagnosis and treatment.
- Chest X-rays and CT scans are essential diagnostic tools, showing increased opacity, volume loss, and shifting of mediastinal structures toward the collapsed lung.
Diagnostic Criteria
- Decreased breath sounds over the affected area
- Dullness to percussion
- Tracheal deviation toward the affected side
- Decreased chest wall movement
- Dyspnea, tachypnea, cough, and in severe cases, cyanosis
Pathophysiology
Atelectasis occurs when alveoli collapse or fail to expand properly, commonly due to airway obstruction, external compression, or surfactant deficiency, as discussed in 1 and 1.
Treatment
Treatment focuses on addressing the underlying cause, which may include:
- Bronchoscopy for obstruction removal
- Chest physiotherapy
- Incentive spirometry
- Early mobilization to promote lung expansion and secretion clearance The most recent and highest quality study, 1, highlights the importance of lung-protective ventilation strategies to prevent atelectasis and reduce postoperative pulmonary complications.
From the Research
Definition and Causes of Atelectasis
- Atelectasis is a state of collapsed and non-aerated region of the lung parenchyma, which is otherwise normal 2.
- This pathological condition is usually associated with several pulmonary and chest disorders and represents a manifestation of the underlying disease, not a disease per se 2.
- Atelectasis may occur in three ways:
- airway obstruction
- compression of parenchyma by extrathoracic, intrathoracic, chest wall processes
- increased surface tension in alveoli and bronchioli 2.
Diagnosis of Atelectasis
- Chest radiographs using both the anterior-posterior and lateral projections are mandatory to document the presence of atelectasis 2.
- Differentiation from lobar consolidation may be a clinical dilemma 2.
Treatment of Atelectasis
- The treatment of atelectasis varies depending on duration and severity of the causal disease from chest physiotherapy to postural drainage, bronchodilator and anti-inflammatory therapy 2.
- Persistent mucous plugs should be removed by bronchoscopy 2.
- The combination of chest wall percussion and vibrations, patient positioning to facilitate mucus drainage, coughing, and breathing exercises can be employed for airway clearance 3.
- Bronchoscopic aspiration and lavage are common techniques used to remove retained secretions or mucus plugs 3.
Management of Acute Lung Atelectasis
- Mechanical ventilation and endotracheal intubation can cause airway damage and inflammation resulting in excessive mucus secretions, thereby increasing the risk of respiratory failure post extubation 3.
- Extra support, including oxygen and, rarely, reintubation, can be necessary if lung collapse is diagnosed 3.
- Pulmonary rehabilitation strategies have been a standard aspect of care to prevent lung collapse in postoperative cases since the late 20th century 3.
Note: The study 4 is not relevant to the topic of atelectasis.