pulmonary disorders
Atelectasis
Treatment of Atelectasis
Maximizing cough and deep breathing If obstruction by tumor or foreign body is suspected, bronchoscopy Evidence for the efficacy of most treatments for atelectasis is weak or absent. Nonetheless, commonly recommended measures include Chest Physiotherapy to help maintain ventilation and clearance of secretions, and encouragement of lung expansion techniques such as directed cough, deep breathing exercises, and use of an incentive spirometer. In ambulatory patients, exercise (eg, walking) is a desirable way to promote deep breathing. For patients who are not intubated and do not have excessive secretions, continuous positive airway pressure may help. For patients who are intubated and Overview of Mechanical Ventilation , positive end-expiratory pressure and/or higher tidal volume ventilation may help. Avoiding oversedation helps ensure ventilation and sufficient deep breathing and coughing. However, severe pleuritic pain may impair deep breathing and coughing and may be relieved only with opioids. Thus, many clinicians prescribe opioid analgesics in doses sufficient to relieve pain and advise patients to consciously cough and take deep breaths periodically. In certain postoperative patients, epidural analgesia or an intercostal nerve block may be used to relieve pain without causing respiratory depression. Antitussive therapy should be avoided. Most importantly, the cause of atelectasis (eg, mucous plug, foreign body, tumor, mass, pulmonary effusion) should be treated. For persistent mucous plugging, nebulizeddornase alfaand sometimes bronchodilators are tried.Acetylcysteineis usually avoided because it can cause bronchoconstriction. If other measures are ineffective or if a cause of obstruction other than mucous plugging is suspected, bronchoscopy should be done. 