Which of the following measures can reduce or prevent the incidence of atelectasis

Atelectasis is collapse of lung tissue with loss of volume. Patients may have dyspnea or respiratory failure if atelectasis is extensive. They may also develop pneumonia. Atelectasis is usually asymptomatic, but hypoxemia and pleuritic chest pain may be present in certain cases. Diagnosis is by chest x-ray. Treatment includes maintaining coughing and deep breathing and treating the cause.

The natural tendency for open air spaces such as the alveoli to collapse is countered by the following:

• Surfactant (which maintains surface tension)

• Continuous breathing (which keeps the alveoli open)

• Intermittent deep breathing (which releases surfactant into the alveoli)

• Periodic coughing (which clears the airways of secretions)

Major consequences of atelectasis include underventilation (with hypoxia and ventilation/perfusion [V/Q] mismatch) and pneumonia.

The most common factors that can cause atelectasis include the following:

• Intrinsic obstruction of airways (eg, by foreign body, tumor, mucous plug)

• Suppression of respiration or cough (eg, by general anesthesia, oversedation, pain)

• Supine positioning, particularly in obese patients and those with cardiomegaly

Thoracic and abdominal surgeries are very common causes because they involve general anesthesia, opioid use (with possible secondary respiratory depression), and often painful respiration. A malpositioned endotracheal tube can cause atelectasis by occluding a mainstem bronchus.

Less common causes of atelectasis include surfactant dysfunction and lung parenchymal scarring or tumor.

• Chest x-ray

Atelectasis should be suspected in patients who have any unexplained respiratory symptoms and who have risk factors, particularly recent major surgery. Atelectasis that is clinically significant (eg, that causes symptoms, increases risk of complications, or meaningfully affects pulmonary function) is generally visible on chest x-ray; findings can include lung opacification and/or loss of lung volume.

• 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 Chest Physiotherapy Chest physiotherapy consists of external mechanical maneuvers, such as chest percussion, postural drainage, and vibration, to augment mobilization and clearance of airway secretions. It is indicated... read more 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.

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, nebulized dornase alfa and sometimes bronchodilators are tried. N-Acetylcysteine is 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.

After surgery, early ambulation and lung expansion techniques (eg, coughing, deep breathing exercises, incentive spirometry) may also decrease risk.

• Atelectasis is reversible collapse of lung tissue with loss of volume; common causes include intrinsic or extrinsic airway compression, hypoventilation, and a malpositioned endotracheal tube.

• A large area of atelectasis may cause symptomatic hypoxemia, but any other symptoms are due to the cause or a superimposed pneumonia.

• Diagnosis is by chest x-ray; if the cause is not clinically apparent, bronchoscopy or chest computed tomography may be needed.

• Treatment involves maximizing coughing, deep breathing, and, whenever possible, walking.

How can atelectasis be prevented?

Which of the following measures can reduce or prevent atelectasis in a post operative patients?

Which of the following methods can help to reduce the likelihood of atelectasis?

What is atelectasis and how is it prevented?