What is atelectasis?
This is a medical condition wherein there is a collapse on a part of a lung or there is a complete lung collapse. Basically, the condition arises when the gas exchange within the alveoli is insufficient as there is fluid buildup in the lungs. This is commonly detected by doing chest x-rays and other radiological studies following chest surgeries.
The usual age of affectation for atelectasis is 60 years old and is a most common result of a chest surgical intervention. There is no specific gender or race of affectation.
This problem has both acute and chronic forms. Acute Atelectasis is most common in postoperative complications when a person is having chest or abdominal surgery. Atelectasis can also occur due to injuries like falling, stabbing or car accident.
Chronic atelectasis comes in 2 types- middle lobe syndrome and rounded atelectasis.
- Middle lobe syndrome. The middle lobe of the right lung contracts because of the pressure on the bronchus due to a tumor. This then develops into a respiratory problem like pneumonia and if unresolved, it can lead to chronic inflammation.
- Rounded atelectasis. The outer part of the lung/s slowly collapses that result to scarring of the pleura.
The word atelectasis comes from the Greek words atelec which means imperfect or incomplete and ketosis means extension or expansion.
Atelectasis of lung
This problem is thought to be a postoperative pulmonary complication. This is observed when the physician does the physical examination and there is dullness upon percussion and the breath sounds are not heard when auscultation is done. Symptoms of the condition include fever and cough.
When the condition is progresses to its worst state rapid breathing, difficulty of breathing, wheezing, and hemoptysis (coughing out blood) would develop. The condition is then confirmed via ABG or arterial blood gas, chest-x-rays or chest CT scans. Physical presentation includes increased respiration and wheezing.
Compression atelectasis is also identified as passive atelectasis or passive atelectasis. This condition happens when the fluid collection in the pleural space cause compression of the lung. The condition also develops when there is a lesion in the thorax. One cause of compression atelectasis is pleural effusions where it prominently occurs in the lower area of a lung lobe. Pneumothorax is also another cause of this problem. pneumothorax is air leakage into the pleural cavity.
This is referred to as “gravity-dependent atelectasis”. This is a common type of atelectasis wherein the weight of the lung is increased; the dependent region is compressed and eventually collapses. It also occurs when the alveoli deflates. Pulmonary edema is one of the causes of dependent atelectasis and this can be relieved by switching from supine to prone position.
This is also called as the plate-like atelectasis wherein there is a disc or plate-like appearance on the x-ray result. Physicians believe that this happens when the patient is breathing shallowly or is hypoventilating after an abdominal or thoracic surgery; by pulmonary embolism or lower respiratory tract infection.
When seen in chest-x-rays, the collapsed area of the lung forms a horizontal appearance. When viewed on the side, result looks like a compact disc. This is also termed as plate atelectasis but presents no serious consequence to health. However, this should be checked every 3 to 6 months to know if the problem has worsened and to properly monitor the case.
This type of atelectasis involves decreased lung volume because of the obstruction of subsegmental or small bronchus. In chest radiograph, the affected area seemed to be opaque. Patients with hypoventilation, pulmonary embolism and respiratory tract infection are commonly affected.
In general, atelectasis develops because of obstruction or from a nonobstructive factor such as increased pressure outside the lung. Usually, atelectasis develops after an intensive chest surgical intervention. There are many causes of atelectasis and these are:
- Foreign body obstruction is only common to children.
- Bronchial obstruction due to: endotracheal tumors, foreign body obstruction, aneurysm that compresses the bronchi, and mucus plugs from persistent sputum collection.
- External pulmonary compression caused by pleural fluid due to pleural effusion or pneumothorax. Pleural effusion involves fluid buildup in the pleura while pneumothorax is due to air leakage in the pleural space. Both conditions are prone to lung collapse that is why medical intervention is essential when these conditions are suspected.
- Oxygen toxicity and ARDS or acute respiratory distress syndrome
- Lung surfactant problems which can cause alveolar instability
- Bronchogenic carcinoma
- Inflammatory problems like tuberculosis
- Mucous plugs accumulation is a common cause of atelectasis. During a surgical procedure, some intraoperative drugs result to mucous secretions thus resulting to accumulation.
- Misplacement of endotracheal tube
- Metastatic neoplasm that causes bronchial obstruction
- Cardiac bypass surgery
- Prolonged shallow breathing
- Right middle lobe syndrome or Brock syndrome
There are also precipitating factors that influence development of atelectasis:
- Premature birth. This can result to atelectasis as the infant has underdeveloped lung tissues.
- Impaired swallowing. A common condition to the elderly that can result to aspiration.
- Underlying lung conditions is a common precipitating factor for atelectasis.
- Respiratory muscle weakness
- Increased weight or obesity can precipitate atelectasis development as the fat in the abdominal area would served as the obstruction in the diaphragm making respiration a difficult task.
Atelectasis Signs and Symptoms
- Dyspnea or difficulty in breathing
- Rapid, deep breathing develops as one compensates for proper oxygenation
- Cyanosis or bluish discoloration of the fingers which means there is not enough oxygen in the peripheral area
- Fever (low-grade) which is a common sign when there is infection (This is also termed as atelectasis fever)
- Low blood pressure
- The patient may not feel the other symptoms except that they may develop gradual dyspnea and body weakness
- One should report for extreme difficulty in breathing as this symptom requires immediate medical assistance.
The physician will take the comprehensive family and medical history as well as doing physical examination. Then the following tests will be made to confirm atelectasis:
- Chest x-ray. The result of the test would show that the affected area appears to be airless. A chest X-ray also assists in identifying for a possible presence of obstructive material in the respiratory tract. Underlying conditions such as pneumonia can be identified and would assist in finding the root cause of atelectasis.
- Pulse oximetry. This checks the oxygen saturation of the blood.
- CT scan or Computed Tomography scan is done when blockage in the bronchial area is suspected. This test helps identify presence of lung collapse.
- Arterial blood gas or ABG is also ordered wherein hypoxemia (decreased oxygenated blood) is determined.
- Bronchoscopy. This is a procedure wherein the physician or medical professional will evaluate the patient’s lung as well as the voice box, the trachea, and the branches of the bronchi through a bronchoscope. Bronchoscopy has two functions: to diagnose and to treat respiratory problems.
It is used to diagnose lung problems because conditions like persistent or unexplained cough, suspicions of atelectasis, blood in the sputum; mass, module or inflammation seen in the chest x-ray may indicate a number of lung conditions. It can also be used for treatment like removing the foreign body present in the airway, placing a stent or a tiny tube in a collapsed airway due to tumor/s, and removing a mass or an abnormal growth in the airway.
It is important to note that when a patient will undergo bronchoscopy, the patient should not take anything per mouth or NPO, 12 midnight on the day of the procedure. There are medications to be on hold such as blood thinners like warfarin or aspirin, NSAIDs or non-steroidal anti-inflammatory drugs such as ibuprofen.
In general, the main aim in atelectasis treatment is proper oxygenation. Giving supplemental oxygen is the automatic intervention to this kind of patient in order to relieve the distress from difficulty of breathing. Atelectasis treatment greatly depends on the underlying problem.
In Postoperative atelectasis
- Surgeons suggest that preventing postoperative atelectasis is still the best remedy. Postanesthetic narcotics should be avoided because these drugs depress the cough reflex.
- Ambulation should be promoted and the use of spirometry is also important.
- Deep breathing exercises should be facilitated.
- Nebulized bronchodilator and the humidity of the environment can be a factor to help liquefy the secretions.
- Adequate oxygenation is important to help expand the lungs after surgery.
- Antibiotics are also given because secondary atelectasis is due to infections. Broad-spectrum antibiotics are commonly prescribed.
- Bronchodilator can be used to promote sputum expectoration.
Medical treatment includes the use of bronchodilators such as Foradil and Serevent. These help facilitate lung expansion as the bronchial tubes as targeted. Drugs that help cough out the mucous are prescribed such as acetylcystein and dornase alfa.
Non-pharmaceutical therapy is done to improve the coughing and the clearance of secretion from the airways. This includes chest physiotherapy or back tapping, chest wall percussion and vibration, and huffing or forced expiration technique. There is also a device that can help facilitate mucous drainage such as the air-pulse vibrator vest.
The use of incentive spirometry would assist us in determining the progress of the patient, every after respiratory treatment. In a simple way, postural drainage should be performed. This can be down with positioning the patient’s head lower than the chest area allowing mucus drainage.
When the patient is able to expectorate sputum, it is then evaluated by the characteristics of the sputum such as the volume, the weight and viscosity.
Prevention of atelectasis can be done, especially to patients with a definite history of respiratory problem. The following are interventions that can help prevent atelectasis:
- Keep small objects from children. This can help a parent avoid the development of respiratory obstruction that eventually leads to atelectasis. When choosing toys for the kids, you should be responsible enough and know what is “child-friendly”.
- Break the habit. One should stop smoking as this can only induce mucus production and even damage your lung structures such as the alveoli.
- Practice deep-breathing exercises. This is essential to patients who recently underwent a chest surgery.
- Proper position of oneself. This facilitates proper drainage of mucus thus making oneself away from developing atelectasis.
by on in Lungs and Respiratory System