Atelectasis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Atelectasis}} | {{Atelectasis}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Cherry}} | ||
==Overview== | |||
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. | |||
==Medical Therapy== | ==Medical Therapy== | ||
=== | 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]]. | |||
* The various types of [[chest physiotherapy]] used in patients include: | |||
** Huffing: A technique of [[Expiration|forced expiration]] | |||
** Postural drainage (Lying in the left lateral decubitus position away from the affected side to allow its drainage) | |||
** Chest wall percussion | |||
* 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. | |||
* 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. | |||
* 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. | |||
* 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=== | |||
* Obstructive atelectasis due to [[Mucus|mucus plugs]] | |||
** Non-pharmacological therapy: | |||
*** Preferred regimen (1): [[Coughing|Coughing exercises]] | |||
*** Preferred regimen (2): [[Suction|Nasotracheal suctioning]] | |||
*** Preferred regimen (3): [[Bronchoscopy|Fiberoptic bronchoscopy]] | |||
**Pharmacological therapy: | |||
*** Preferred regimen (1): [[DNase|Nebulized dornase alfa (DNase)]] 2.5 mg nebulizer q24h or q12h | |||
*** Preferred regimen (2): [[N-acetylcysteine|N-acetylcysteine aerosol]] 5-10 mL of 10% or 20% solution by nebulization q6-8hr | |||
*** Preferred regimen (3): [[Antitussive|Antitussive therapy]] | |||
* Postoperative atelectasis | |||
** Preferred regimen (1): [[Intubation]] | |||
** Preferred regimen (2): [[Mechanical ventilation|Mechanical support]] | |||
** Preferred regimen (3): [[Positive pressure ventilation]] | |||
** Preferred regimen (4): [[Positive airway pressure|CPAP]] | |||
* Obstructive atelectasis due to a tumor | |||
** Preferred regimen (1): [[Surgery]] | |||
** Alternative regimen (1): [[Radiation therapy]] | |||
** Alternative regimen (2): [[Chemotherapy]] | |||
** Alternative regimen (3): [[Laser therapy]] | |||
* Infectious atelectasis | |||
** Preferred regimen (1): [[Cefuroxime]] 250-500 mg PO q12hr for 10 days | |||
** Alternative regimen (1): [[Cefuroxime]] 500-750 mg IV q8hr; switch to oral therapy | |||
**Alternative regimen (2): [[Cefuroxime]] 250-500 mg PO q12hr for 5-10 days | |||
** Alternative regimen (3): [[Cefaclor]] 250-500 mg PO q8hr | |||
** Alternative regimen (4): [[DNase]] 2.5 mg nebulizer q24h or q12h | |||
==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.
- 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 immobilization.
- The various types of chest physiotherapy used in patients include:
- Huffing: A technique of forced expiration
- Postural drainage (Lying in the left lateral decubitus position away from the affected side to allow its drainage)
- Chest wall percussion
- Other non pharmacological therapies used in patients with atelectasis include breathing and coughing exercises, early ambulation, nasotracheal suctioning and fibreoptic bronchoscopy.[1]
- Obstructive atelectasis due to mucus plugs may be treated with nebulized dornase alfa (DNase) and N-acetylcysteine, which helps in the lysis of mucus secretions. Antitussive therapy is used for the treatment of cough in these patients.
- Resorption atelectasis due to airway obstruction is initially treated with coughing exercises and nasotracheal suctioning. If these interventions fail, fiberoptic bronchoscopy is used to clear the obstruction.[2]
- Passive and adhesive atelectasis require positive end-expiratory pressure to prevent alveloar collapse.
- Patients with atelectasis have a high chace of developing secondary infection in atelectatic sites. Patients with signs of infection should be administered broad spectrum antibiotics. DNase is also useful for pediatric patients with infectious atelectasis, in the absence of underlying cystic fibrosis.[3]
- Postoperative atelectasis may be prevented by ensuring judicious use of 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 incentive spirometry, early ambulation, humidifiers, nebulized bronchodilators (Albuterol, Metaproterenol), chest physiotherapy, deep breathing, coughing exercises and supplemental oxygen in order to maintain an arterial oxygen saturation of greater than 90 percent is recommended in patients. Intubation, mechanical support, positive pressure ventilation and CPAP help in the prevention of alveolar collapse, thereby assisting in lung inflation in patients with atelectasis.
- Obstructive atelectasis due to a tumor may be treated using modalities such as surgery, radiation therapy, chemotherapy, or laser therapy.
Treatment based on cause of atelectasis
- Obstructive atelectasis due to mucus plugs
- Non-pharmacological therapy:
- Preferred regimen (1): Coughing exercises
- Preferred regimen (2): Nasotracheal suctioning
- Preferred regimen (3): Fiberoptic bronchoscopy
- Pharmacological therapy:
- Preferred regimen (1): Nebulized dornase alfa (DNase) 2.5 mg nebulizer q24h or q12h
- Preferred regimen (2): N-acetylcysteine aerosol 5-10 mL of 10% or 20% solution by nebulization q6-8hr
- Preferred regimen (3): Antitussive therapy
- Non-pharmacological therapy:
- Postoperative atelectasis
- Preferred regimen (1): Intubation
- Preferred regimen (2): Mechanical support
- Preferred regimen (3): Positive pressure ventilation
- Preferred regimen (4): CPAP
- Obstructive atelectasis due to a tumor
- Preferred regimen (1): Surgery
- Alternative regimen (1): Radiation therapy
- Alternative regimen (2): Chemotherapy
- Alternative regimen (3): Laser therapy
- Infectious atelectasis
- Preferred regimen (1): Cefuroxime 250-500 mg PO q12hr for 10 days
- Alternative regimen (1): Cefuroxime 500-750 mg IV q8hr; switch to oral therapy
- Alternative regimen (2): Cefuroxime 250-500 mg PO q12hr for 5-10 days
- Alternative regimen (3): Cefaclor 250-500 mg PO q8hr
- Alternative regimen (4): DNase 2.5 mg nebulizer q24h or q12h
References
- ↑ 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.
- ↑ 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.
- ↑ 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.