What is the treatment for atelectasis?

From the Guidelines

Treatment of Atelectasis Treatment of atelectasis typically involves a multimodal approach, including respiratory physiotherapy, bronchodilators such as albuterol (2.5-5mg via nebulizer every 4-6 hours), and mucolytics like acetylcysteine (200-400mg orally or via nebulizer every 6-8 hours) 1.

Key Components of Treatment

• Positive expiratory pressure (PEP) therapy, such as with a PEP device set at 10-20 cmH2O, may be used to help re-expand collapsed lung tissue 1.
• In cases of underlying infection, antibiotics such as ceftriaxone (1-2g intravenously every 12-24 hours) or azithromycin (250-500mg orally or intravenously every 24 hours) may be administered for 7-14 days.
• Recruitment maneuvers (RMs) and individualized PEEP settings can reduce postoperative atelectasis while improving intraoperative gas exchange and driving pressures 1.

Considerations for Specific Patient Populations

• Patients with obesity may require higher cut-off values of protective driving pressure than patients without obesity due to low lung capacity or physiologic changes occurring during the surgical procedure 1.
• Pressure-controlled ventilation (PCV) or volume-controlled ventilation (VCV) can be used with inversed respiratory ratio, ideally avoiding increases in driving pressure from adjustments in PEEP 1.

Additional Therapies

• Nebulized hypertonic saline has been shown to have small benefits even in the absence of bronchiectasis in terms of improving lung function and sputum burden 1.
• Autogenic drainage, oscillating positive expiratory pressure devices, and high-frequency chest compression devices offer additional mucus clearance advantages to patients with significant mucus production and clearance problems 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 INDICATIONS AND USAGE 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

The treatment for atelectasis due to mucous obstruction is acetylcysteine as an adjuvant therapy, which can help loosen and clear mucous secretions 2 3. Key points:

• Acetylcysteine is used to treat conditions with abnormal, viscid, or inspissated mucous secretions
• It is specifically indicated for atelectasis due to mucous obstruction
• It works by breaking down disulfide linkages in mucous, lowering its viscosity and making it easier to clear.

From the Research

Treatment Options for Atelectasis

The treatment for atelectasis varies depending on the duration and severity of the causal disease. Some of the treatment options include:

• Chest physiotherapy to help loosen and clear mucus from the lungs 4
• Postural drainage to help drain mucus from the lungs 4
• Bronchodilator and anti-inflammatory therapy to help open up the airways and reduce inflammation 4, 5
• Removal of persistent mucus plugs by bronchoscopy 4, 6
• Temporary positive expiratory pressure (TPEP) as an alternative approach in the treatment of persistent atelectasis 7
• Recruitment maneuvers and maintaining positive end-expiratory pressure (PEEP) until extubation to minimize lung collapse 8
• Anti-inflammatory medications, clarithromycin, and inhaled salbutamol for patients with asthma and RML atelectasis 5
• Chest-physiotherapy starting on the sixth day for patients with asthma and RML atelectasis 5

Specific Treatment Approaches

For patients with Steinert disease, TPEP has been shown to be an effective treatment for persistent atelectasis 7. For postoperative patients with acute lung atelectasis due to airway mucus plugging, the combination of chest physiotherapy and bronchoscopy has been shown to be effective in removing retained secretions and preventing lung collapse 6. For pediatric patients under general anesthesia, recruitment maneuvers and maintaining PEEP until extubation have been shown to be effective in minimizing lung collapse 8. For patients with asthma and RML atelectasis, early diagnosis and treatment with anti-inflammatory medications and aggressive therapy within the first week have been shown to be effective in preventing complications 5.