Atelectasis
Atelectasis is a condition in which part of the lung collapses, resulting in loss of lung-tissue volume, particularly within the alveoli. This can reduce gas exchange of O2 and CO2 and is often reversible, although it usually occurs secondary to an underlying pathology. Early identification and treatment are important to prevent further complications associated with prolonged or severe collapse of lung tissue.
Clinical Implications
Atelectasis can lead to several physiological changes and complications, including:
Reduced lung compliance: The lungs become less compliant, making breathing more difficult.
Hypoxemia: Reduced oxygen content in the blood, which may lead to further oxygen deficiency in tissues and organs.
Increased pulmonary vascular resistance (PVR): Increased pressure within the pulmonary circulation can contribute to cardiovascular strain.
Inflammation: A local biological response in the tissue may worsen the condition.
Local immune dysfunction: Reduced immune defense in the affected region can make the tissue more susceptible to infection.
Prevention
Atelectasis may be reduced by avoiding general anesthesia when possible. When anesthesia is unavoidable, the following measures may help prevent atelectasis:
Use of continuous positive airway pressure (CPAP).
Low tidal volume and the lowest feasible FiO2 during induction to limit absorption atelectasis.
Positive end-expiratory pressure (PEEP) and lung-recruitment maneuvers.
Early mobilization after surgical procedures.
Adequate pain relief to reduce immobilization and breathing difficulties.
Minimizing the use of parenteral opioid medication, as opioids may suppress respiration and worsen atelectasis.
Treatment
Treatment of atelectasis depends on the duration and severity of the condition. Management may range from non-invasive methods such as physiotherapy and pharmacological treatment to more invasive procedures such as bronchoscopy, depending on the patient's condition. Atelectasis can damage the alveolar-capillary barrier, reduce pulmonary fluid clearance and increase protein permeability in the lungs. This may make patients more susceptible to infection and can reduce antibiotic penetration into lung tissue.
Clinical Presentation
Symptoms of atelectasis are often nonspecific and may include:
Chest pain: Caused by compression and inflammation in the collapsed tissue.
Shortness of breath: Due to reduced lung capacity and impaired gas exchange.
Shallow breathing pattern: Often used to minimize movement on the affected side.
Reduced chest expansion: Reduced expansion of the affected side of the chest.
Increased respiratory rate: A compensatory response to impaired oxygenation.
Increased work of breathing: Due to impaired ventilation.
Reduced breath sounds on the ipsilateral side: Particularly in upper-lobe atelectasis, bronchial breath sounds may be heard.
Diagnosis
Diagnosing atelectasis may require several imaging and diagnostic investigations, including:
Chest X-ray: Used to visualize the extent of lung collapse[2][27].
Bronchoscopy: Used to inspect the airways and remove possible obstructions[28].
CT scan: Provides a more detailed assessment of the location and extent of collapse[28].
Ultrasound examination: May also be useful for visualizing atelectasis in selected cases[29][30][31].
Physiotherapy Treatment
Different physiotherapy interventions have been shown to be useful in resolving atelectasis and may also be used preventively or prophylactically before surgery¹.
The following table lists physiotherapy interventions that may be used for patients with atelectasis¹²³⁴⁵⁶⁷⁸⁹:
Airway-clearance techniques
Suctioning of respiratory secretions.
Percussion and vibration therapy.
Positive expiratory pressure.
Active cycle of breathing techniques.
Postural drainage.
High-frequency oscillations (CHFO) may be delivered through the MetaNeb system.
Mechanical insufflation-exsufflation.
Manual lung hyperinflation.
Breathing exercises
Incentive spirometry.
Sustained maximal inspiration.
Intermittent positive-pressure breathing.
Positioning
Kinetic therapy: Continuous rotation of the patient along the longitudinal axis to at least 40° on each side using a specialized bed.
Turn the patient from side to side.
Prone positioning.
Early mobilization
Sitting on the edge of the bed.
Getting out of bed on the first postoperative day.
Walking short distances in the room or corridor on the second postoperative day.
Non-Conservative Treatment
Flexible bronchoscopy can be used both diagnostically and therapeutically in patients with atelectasis. It is considered a safe treatment for lung collapse and may be used in the following situations:
When secretions with an air-bronchogram pattern are present in segmental bronchi causing lobar atelectasis.
When standard chest physiotherapy has not produced a satisfactory response.
Life-threatening partial or complete lung atelectasis.
When vigorous chest therapy is not beneficial or is contraindicated, for example in chest trauma, unstable vertebral fractures, extensive burns, smoke inhalation or neuromuscular disease.
When there is uncertainty about the diagnosis.
Clinical Assessment
Atelectasis often develops secondary to an underlying condition or as a postoperative complication and may cause substantial morbidity or mortality. The literature is not uniform regarding whether it can always be prevented, but both conservative and non-conservative approaches have shown benefit in treatment and prevention of atelectasis¹.
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