What are the implications of bibasilar (basilar) atelectasis (collapse of lung tissue) with scarring?

From the Guidelines

Bibasilar atelectasis/scar should be managed with strategies to improve lung recruitment and prevent further atelectrauma, including the use of higher PEEP levels in mechanically ventilated patients with moderate or severe ARDS, as evidenced by the IPDMA of higher versus lower PEEP trials 1.

Key Considerations

• The primary goal in managing bibasilar atelectasis/scar is to improve lung expansion and prevent further tissue damage.
• Higher PEEP strategies have been shown to improve oxygenation and reduce mortality in patients with moderate or severe ARDS, with a significant advantage in reducing atelectasis and increasing end-expiratory lung volume 1.
• Recruitment maneuvers (RMs) may also be beneficial in reducing atelectasis and improving lung function, although the evidence is based on a variety of maneuvers and may be associated with complications such as hemodynamic compromise and barotrauma 1.

Management Strategies

• Deep breathing exercises and incentive spirometry can help improve lung expansion and prevent further atelectasis.
• Regular position changes and early mobilization are essential, particularly for bedridden patients.
• Adequate hydration and chest physiotherapy may be beneficial for secretion clearance.
• Appropriate antibiotics may be prescribed if the condition is related to an infection.

Evidence-Based Recommendations

• The use of higher PEEP levels in mechanically ventilated patients with moderate or severe ARDS is supported by the IPDMA of higher versus lower PEEP trials, which showed a significant reduction in mortality and improvement in oxygenation 1.
• RMs may be considered as an adjunctive therapy to improve lung recruitment and reduce atelectasis, although the choice of maneuver and potential risks should be carefully considered 1.

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.
• It 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: (i) airway obstruction; (ii) compression of parenchyma by extrathoracic, intrathoracic, chest wall processes; and (iii) 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.
• Non-invasive mechanical ventilation (NIMV) may be useful in the treatment of atelectasis in some critical patients 3.
• Pulmonary expansion manoeuvres, such as chest compression-decompression and chest block, did not improve ventilatory mechanics, the incidence of atelectasis, oxygenation, the duration of mechanical ventilation, the length of stay in the ICU and hospital, or mortality in individuals on mechanical ventilation 4.
• Noninvasive pressure support ventilation (NIPSV) was superior to continuous positive airway pressure (CPAP) regarding the improvement of atelectasis based on radiological score, but did not confer any additional clinical benefit 5.

Specific Considerations for Bibasilar Atelectasis/Scar

• There is limited information available on the specific treatment of bibasilar atelectasis/scar.
• However, the general principles of treating atelectasis, such as removing mucous plugs and using non-invasive mechanical ventilation, may still apply 2, 3.