Atelectasis medical therapy: Difference between revisions

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{{Atelectasis}}
{{Atelectasis}}
{{CMG}}
{{CMG}} {{AE}} {{Cherry}}
==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The primary treatment for atelectasis is management of the underlying cause. Besides this, supportive therapy for atelectasis includes [[chest physiotherapy]], [[breathing]] and [[Coughing|coughing exercises]], [[Ambulation|early ambulation]], [[Suction|nasotracheal suctioning,]] [[Humidifier Lung|humidifiers]], nebulized [[Bronchodilator|bronchodilators]] and supplemental [[oxygen]] in order to maintain an [[Oxygen saturation|arterial oxygen saturation]] of greater than 90 percent. [[Intubation]], mechanical support, [[positive pressure ventilation]] and [[Positive airway pressure|continous positive airway pressure (CPAP)]] help in the prevention of [[Alveolus|alveolar]] collapse, thereby assisting in lung inflation in patients with atelectasis.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
Treatment of atelectasis primarily involves treatment of the underlying cause.
Treatment of atelectasis primarily involves treatment of the underlying cause. Besides this, supportive therapy may be given to patients.  
 
* [[Chest physiotherapy]] helps in the clearance of secretions and improvement of [[cough]] in patients with atelectasis. It is the initial non-pharmacological intervention of choice preferred in patients. However, it may be contraindicated in patients with trauma to the chest wall or [[Immobility|immobilization]].
Besides this, supportive therapy may be given to patients. These measures include:
* The various types of [[chest physiotherapy]] used in patients include:
 
** Huffing: A technique of [[Expiration|forced expiration]]
Chest physiotherapy: helps in the clearance of secretions and improvement of cough
** Postural drainage (Lying in the left lateral decubitus position away from the affected side to allow its drainage)
 
** Chest wall percussion
The various types of chest physiotherapy used in patients include:
* Other non pharmacological therapies used in patients with atelectasis include [[breathing]] and [[Coughing|coughing exercises]], early [[Walking|ambulation]], [[Suction|nasotracheal suctioning]] and [[Bronchoscopy|fibreoptic bronchoscopy]].<ref name="pmid24749266">{{cite journal |vauthors=Mironov AV, Pinchuk TP, Selina IE, Kosolapov DA |title=[Emergency fiberoptic bronchoscopy for diagnostics and treatment of lung atelectasis] |language=Russian |journal=Anesteziol Reanimatol |volume= |issue=6 |pages=51–4 |date= 2013 |pmid=24749266 |doi= |url= |author=}}</ref>
 
* [[Atelectasis|Obstructive atelectasis]] due to mucus plugs may be treated with nebulized [[Deoxyribonuclease|dornase alfa (DNase)]] and [[Acetylcysteine|N-acetylcysteine]], which helps in the lysis of [[mucus]] secretions. [[Antitussive|Antitussive therapy]] is used for the treatment of cough in these patients.
Huffing: A technique of forced expiration
* Resorption atelectasis due to [[airway obstruction]] is initially treated with [[Coughing|coughing exercises]] and [[Suction|nasotracheal suctioning]]. If these interventions fail, [[Bronchoscopy|fiberoptic bronchoscopy]] is used to clear the obstruction.<ref name="pmid16428718">{{cite journal |vauthors=McCool FD, Rosen MJ |title=Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=250S–259S |date=January 2006 |pmid=16428718 |doi=10.1378/chest.129.1_suppl.250S |url= |author=}}</ref>
 
* Passive and adhesive atelectasis require [[positive end-expiratory pressure]] to prevent alveloar collapse.
Postural drainage
* Patients with atelectasis have a high chace of developing [[Infection|secondary infection]] in atelectatic sites. Patients with signs of [[infection]] should be administered [[Antibiotic|broad spectrum antibiotics]]. [[Deoxyribonuclease|DNase]] is also useful for pediatric patients with infectious atelectasis, in the absence of underlying [[cystic fibrosis]].<ref name="pmid16137347">{{cite journal |vauthors=Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ |title=DNase and atelectasis in non-cystic fibrosis pediatric patients |journal=Crit Care |volume=9 |issue=4 |pages=R351–6 |date=August 2005 |pmid=16137347 |pmc=1269442 |doi=10.1186/cc3544 |url= |author=}}</ref>
 
* Postoperative atelectasis may be prevented by ensuring judicious use of [[Anesthesia|anaesthetic agents]] known to cause narcosis. Narcotic use should be kept to a minimum to avoid depression of the [[cough reflex]]. Use of [[epidural analgesia]] in patients with underlying pulmonary disease is advocated. In addition to this, the use of [[Spirometry|incentive spirometry]], [[Ambulation|early ambulation]], [[Humidifier Lung|humidifiers]], [[Bronchodilators|nebulized bronchodilators]] ([[Albuterol]], [[Metaproterenol]]), [[chest physiotherapy]], [[Diaphragmatic breathing|deep breathing]], [[Coughing|coughing exercises]] and [[Oxygen|supplemental oxygen]] in order to maintain an [[Oxygen saturation|arterial oxygen saturation]] of greater than 90 percent is recommended in patients. [[Intubation]], mechanical support, [[positive pressure ventilation]] and [[Positive airway pressure|CPAP]] help in the prevention of alveolar collapse, thereby assisting in lung inflation in patients with atelectasis.
Chest wall percussion and vibration
* Obstructive atelectasis due to a [[tumor]] may be treated using modalities such as [[surgery]], [[radiation therapy]], [[chemotherapy]], or [[Laser|laser therapy]].
 
===Treatment based on cause of atelectasis===
Nebulized dornase alfa (DNase) help in the management of mucus plugs leading to obstruction
 
Fiberoptic bronchoscopy in case of resorption atelectasis due to airway obstruction, not resolving with nasotracheal suctioning or coughing
 
Chest physiotherapy may be contraindicated in those patients with trauma to the chest, immobilization
 
In passive and adhesive atelectasis, positive end-expiratory pressure is considered
 
Broad spectrum antibiotics in case of any signs of infection
 
N –acetylcysteine: for treatment of mucus expectoration
 
Postoperative atelectasis:
 
Judicious use of anaesthetic agents known to cause narcosis
 
Sparing use of narcotics to avoid depression of the cough reflex
 
Use of epidural analgesia in patients with underlying pulmonary disease is advocated
 
Incentive spirometry
 
Early ambulation
 
Humidifiers
 
Nebulized bronchodilators
 
Chest physiotherapy  
 
Patient should be instructed to inspire deeply and cough
 
Supplemental oxygen: arterial oxygen saturation of greater than 90 %
 
Intubation and mechanical support
 
Positive pressure ventilation
 
CPAP
 
Antitussive therapy
 
Prevention of further atelectasis involves:
Prophylactic maneuvers preferred in patients include:
Placement of the patient in the lateral decubitus position to allow drainage
Chest physiotherapy
Incentive spirometry
Deep breathing exercises
Coughing exercises
Instructions for early ambulation
 
 
DNase: useful for pediatric patients with infectious atelectasis in non-cystic fibrosis patients
 
 
===Device Based Therapy===
Treatment is directed at correcting the underlying cause.  Post-surgical atelectasis is treated by [[physiotherapy]], focusing on deep breathing and encouraging coughing. An [[incentive spirometer]] is often used as part of the breathing exercises. [[Ambulation]] is also highly encouraged to improve lung inflation.  People with chest deformities or [[neurologic]] conditions that cause shallow breathing for long periods may benefit from mechanical devices that assist their breathing. One method is [[continuous positive airway pressure]], which delivers pressurized air or oxygen through a nose or face mask to help ensure that the alveoli do not collapse, even at the end of a breath. This is helpful, as partially-inflated alveoli can be expanded more easily than collapsed alveoli.  Sometimes additional respiratory support is needed with a mechanical [[medical ventilator|ventilator]].
 
The primary treatment for acute massive atelectasis is correction of the underlying cause. A blockage that cannot be removed by coughing or by suctioning the airways often can be removed by bronchoscopy. [[Antibiotics]] are given for an infection. Chronic atelectasis often is treated with antibiotics because infection is almost inevitable. In certain cases, the affected part of the lung may be surgically removed when recurring or chronic infections become disabling or bleeding is significant.
 
If a tumor is blocking the airway, relieving the obstruction by surgery, radiation therapy, chemotherapy, or laser therapy may prevent atelectasis from progressing and recurrent obstructive pneumonia from developing.
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
 
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
* Obstructive atelectasis due to [[Mucus|mucus plugs]]
** 2.1 '''Specific Organ system involved 1 '''
** Non-pharmacological therapy:
**: '''Note (1):'''
*** Preferred regimen (1): [[Coughing|Coughing exercises]]  
**: '''Note (2)''':
*** Preferred regimen (2): [[Suction|Nasotracheal suctioning]]
**: '''Note (3):'''
*** Preferred regimen (3): [[Bronchoscopy|Fiberoptic bronchoscopy]]
*** 2.1.1 '''Adult'''
**Pharmacological therapy:
**** Parenteral regimen
*** Preferred regimen (1): [[DNase|Nebulized dornase alfa (DNase)]] 2.5 mg nebulizer q24h or q12h
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*** Preferred regimen (2): [[N-acetylcysteine|N-acetylcysteine aerosol]] 5-10 mL of 10% or 20% solution by nebulization q6-8hr
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*** Preferred regimen (3): [[Antitussive|Antitussive therapy]]
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
* Postoperative atelectasis
**** Oral regimen
** Preferred regimen (1): [[Intubation]]  
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
** Preferred regimen (2): [[Mechanical ventilation|Mechanical support]]
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
** Preferred regimen (3): [[Positive pressure ventilation]]
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
** Preferred regimen (4): [[Positive airway pressure|CPAP]]  
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
* Obstructive atelectasis due to a tumor
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
** Preferred regimen (1): [[Surgery]]
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
** Alternative regimen (1): [[Radiation therapy]]
*** 2.1.2 '''Pediatric'''
** Alternative regimen (2): [[Chemotherapy]]
**** Parenteral regimen
** Alternative regimen (3): [[Laser therapy]]
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
* Infectious atelectasis
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
** Preferred regimen (1): [[Cefuroxime]] 250-500 mg PO q12hr for 10 days
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
** Alternative regimen (1): [[Cefuroxime]] 500-750 mg IV q8hr; switch to oral therapy
**** Oral regimen
**Alternative regimen (2): [[Cefuroxime]] 250-500 mg PO q12hr for 5-10 days
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
** Alternative regimen (3): [[Cefaclor]] 250-500 mg PO q8hr
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
** Alternative regimen (4): [[DNase]] 2.5 mg nebulizer q24h or q12h
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days  
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 17:06, 20 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

The primary treatment for atelectasis is management of the underlying cause. Besides this, supportive therapy for atelectasis includes chest physiotherapy, breathing and coughing exercises, early ambulation, nasotracheal suctioning, humidifiers, nebulized bronchodilators and supplemental oxygen in order to maintain an arterial oxygen saturation of greater than 90 percent. Intubation, mechanical support, positive pressure ventilation and continous positive airway pressure (CPAP) help in the prevention of alveolar collapse, thereby assisting in lung inflation in patients with atelectasis.

Medical Therapy

Treatment of atelectasis primarily involves treatment of the underlying cause. Besides this, supportive therapy may be given to patients.

Treatment based on cause of atelectasis

References

  1. ↑ Mironov AV, Pinchuk TP, Selina IE, Kosolapov DA (2013). "[Emergency fiberoptic bronchoscopy for diagnostics and treatment of lung atelectasis]". Anesteziol Reanimatol (in Russian) (6): 51–4. PMID 24749266.
  2. ↑ McCool FD, Rosen MJ (January 2006). "Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 250S–259S. doi:10.1378/chest.129.1_suppl.250S. PMID 16428718.
  3. ↑ Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ (August 2005). "DNase and atelectasis in non-cystic fibrosis pediatric patients". Crit Care. 9 (4): R351–6. doi:10.1186/cc3544. PMC 1269442. PMID 16137347.

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