ATELECTASIS

Atelectasis refers to the collapse of either part or all of a lung caused by blockage of the air movement through small or large bronchial tubes. Atelectasis can occur abruptly when thick mucous plugs fill the bronchial tubes or when foreign objects, such as peanuts or small toys, are accidentally inhaled. After surgery, atelectasis is especially common because pain and medications prevent patients from taking deep breaths. Atelectasis can develop more gradually when caused by tumors growing inside the bronchial tubes or by processes outside the lung pressing inward, such as tumors, enlarged blood vessels, lymph nodes, or fluid collections. Susceptibility to atelectasis increases with conditions that increase sputum production, such as infection, cystic fibrosis, chronic bronchitis, and bronchiectasis. Impaired ability to cough and take deep breaths caused by chronic illnesses or drugs that decrease alertness also increase vulnerability to atelectasis. Collapse interferes with the lung's ability to supply oxygen to the body.

Some atelectasis may result in chest pain, shortness of breath, and fever. With complete lung collapse, shock may develop as demonstrated by rapid heart rate, low blood pressure, cool and clammy skin, and lethargy. Lung collapse of more gradual onset may not cause symptoms or lead to persistent cough and fever. Diagnosis is made by examination of the chest and by chest x-ray.

Ideally, the cause of bronchial tube obstruction should be eliminated. Measures taken to relieve bronchial obstruction depend on the clinical circumstances. Bronchoscopy is a procedure in which your doctor uses a lighted tube to look into your lung air passages. This procedure may be necessary to help diagnose the cause of atelectasis and to relieve any bronchial tube obstructions if, for instance, a strong cough fails to expel a foreign body or clear phlegm. Surgery or radiation therapy may be required to treat large obstructing tumors. Individuals with chronic lung diseases that cause excessive secretions usually perform special maneuvers to help prevent accumulation of phlegm. Some of these maneuvers are also used by respiratory therapists in postoperative patients to treat or prevent atelectasis. Antibiotics are prescribed if infection is related to the bronchiectasis. Inhalers are used to open up the bronchial tubes. Atelectasis is usually not life threatening but, if untreated, may lead to permanent partial lung collapse, pneumonia, or lung abscess.

Help prevent atelectasis perioperatively by the following:

• Stop smoking as early as possible before surgery.
• Get out of bed as soon as possible after surgery.
• Use an incentive spirometry hourly while awake (a device that helps expand your lungs by encouraging you to take deep, rapid breaths).
• Work with the nurses and respiratory therapists in their efforts to loosen phlegm from your lungs. They may ask you to turn regularly and cough deeply. They may also administer aerosol treatments and "clap" on your back.

• Do not leave small objects, such as peanuts, around small children.
• Avoid dehydration, which can thicken lung secretions.
• Avoid overuse of pain medications in the postoperative period that may interfere with the ability to cough and take deep breaths.

Call your doctor if any of the following occur:

• Persistent cough.
• Blood in sputum.
• Chest pain.
• Persistent fever.
• Increasing shortness of breath.

American Lung Association
1118 Hampton Avenue
St Louis, MO 63139
800-LUNG-USA
www.lungusa.org




Incentive spirometry device in use. (From Frownfelter D, Dean E: Principles and practice of cardiopulmonary physical therapy, ed 3, St Louis, 1996, Mosby. Used by permission.)

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