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Atelectasis

Contents
  1. Read book excerpt
  2. Adult respiratory distress syndrome: Introduction
  3. Adult respiratory distress syndrome Misdiagnosis
  4. Adult respiratory distress syndrome Causes
  5. Adult respiratory distress syndrome Complications
  6. Adult respiratory distress syndrome Treatments
  7. Latest treatments
  8. Clinical trials
  9. Adult respiratory distress syndrome Overview
  10. More book excerpts for Adult respiratory distress syndrome

Atelectasis: Excerpt from Handbook of Diseases

Atelectasis is marked by incomplete expansion of lobules (clusters of alveoli) or lung segments, which may result in partial or complete lung collapse. The collapsed areas are unavailable for gas exchange; unoxygenated blood passes through these areas unchanged, thereby producing hypoxia.

Atelectasis may be chronic or acute and occurs to some degree in many patients undergoing upper abdominal or thoracic surgery. The prognosis depends on prompt removal of any airway obstruction, relief of hypoxia, and reexpansion of the collapsed lung.

Causes

Atelectasis commonly results from bronchial occlusion by mucus plugs and is frequently a problem in patients with chronic obstructive pulmonary disease, bronchiectasis, or cystic fibrosis and in those who smoke heavily. (Smoking increases mucus production and damages cilia.) Atelectasis may also result from occlusion by foreign bodies, bronchogenic carcinoma, and inflammatory lung disease.

Other causes include respiratory distress syndrome of the neonate (hyaline membrane disease), oxygen toxicity, and pulmonary edema, in which alveolar surfactant changes increase surface tension and permit complete alveolar deflation.

External compression, which inhibits full lung expansion, or any condition that makes deep breathing painful may also cause atelectasis. Such compression or pain may result from upper abdominal surgical incisions, rib fractures, pleuritic chest pain, tight dressings around the chest, or obesity (which elevates the diaphragm and reduces tidal volume).

Atelectasis may also result from prolonged immobility, which causes preferential ventilation of one area of the lung over another, or mechanical ventilation using constant small tidal volumes without intermittent deep breaths.

Central nervous system depression (as in drug overdose) eliminates periodic sighing and is a predisposing factor of progressive atelectasis.

Signs and symptoms

Signs and symptoms vary with the cause of collapse, the degree of hypoxia, and any underlying disease but generally include dyspnea. Atelectasis of a small area of the lung may produce only minimal symptoms that subside without specific treatment.

However, massive collapse can produce severe dyspnea, anxiety, cyanosis, diaphoresis, peripheral circulatory collapse, tachycardia, and substernal or intercostal retraction. Also, atelectasis may result in compensatory hyperinflation of unaffected areas of the lung, mediastinal shift to the affected side, and elevation of the ipsilateral hemidiaphragm.

Diagnosis

An accurate patient history, a physical examination, and a chest X-ray provide baseline data for a diagnosis. In some cases, chest computed tomography scan may be necessary to confirm findings. Auscultation reveals diminished or bronchial breath sounds. When much of the lung is collapsed, percussion reveals dullness. However, extensive areas of “microatelectasis” may exist without abnormalities on the chest X-ray. In widespread atelectasis, the chest X-ray shows characteristic horizontal lines in the lower lung zones and, with segmental or lobar collapse, characteristic dense shadows commonly associated with hyperinflation of neighboring lung zones.

If the cause is unknown, diagnostic procedures may include bronchoscopy to rule out an obstructing neoplasm or a foreign body.

Treatment

Appropriate treatment includes incentive spirometry, mucolytic therapy, chest percussion, postural drainage, and frequent coughing and deep-breathing exercises. If these measures fail, bronchoscopy may help remove secretions. Humidity and bronchodilators can improve mucociliary clearance and dilate airways; they’re sometimes used with a nebulizer.

Atelectasis secondary to an obstructing neoplasm may require surgery or radiation therapy. Postoperative thoracic and abdominal surgery patients require an analgesic to facilitate deep breathing, which minimizes the risk of atelectasis.

Special considerations

  • Encourage postoperative and other high-risk patients to cough and deep-breathe every 1 to 2 hours to prevent atelectasis.
  • To minimize pain during coughing exercises in postoperative patients, hold a pillow tightly over the incision; teach the patient this technique as well. Gently reposition these patients often, and help them walk as soon as possible.
  • Administer adequate analgesics to control pain.
  • During mechanical ventilation, maintain tidal volume at 10 to 15 ml/kg of the patient’s body weight to ensure adequate lung expansion. Use the sigh mechanism on the ventilator, if appropriate, to intermittently increase tidal volume at the rate of 10 to 15 sighs per hour.
  • Use an incentive spirometer to encourage deep inspiration through positive reinforcement. Teach the patient how to use the spirometer, and encourage him to use it every 1 to 2 hours.
  • Humidify inspired air and encourage adequate fluid intake to mobilize secretions. To promote loosening and clearance of secretions, use postural drainage and chest percussion.
  • If the patient is intubated or uncooperative, provide suctioning as needed. Use sedatives with discretion because they depress respirations and the cough reflex and suppress sighing.

    CLINICAL TIP: Know that the patient won’t cooperate with treatment if in he’s pain.

  • Assess breath sounds and ventilatory status frequently, and be alert for any changes.
  • Teach the patient about respiratory care, including postural drainage, coughing, and deep breathing.
  • Encourage the patient to stop smoking, to lose weight, or both, as needed. Refer him to appropriate support groups for help.
  • Provide reassurance and emotional support because the patient may be frightened by his limited breathing capacity.

    Book Source Details

    • Book Title: Handbook of Diseases
    • Author(s): Springhouse
    • Year of Publication: 2003
    • Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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    Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



    More About This Book:
    Title: Handbook of Diseases
    Authors: Springhouse
    Publisher: Lippincott Williams & Wilkins
    Copyright: 2003
    ISBN: 1-58255-266-5

     » Next page: Cardiogenic shock (Handbook of Diseases)

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