Atelectasis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

The primary treatment for atelectasis is management of the underlying cause. Besides this, supportive therapy for atelectasis includes chest physiotherapy, breathing and coughing exercises, early ambulation, nasotracheal suctioning, humidifiers, nebulized bronchodilators and supplemental oxygen in order to maintain an arterial oxygen saturation of greater than 90 percent. Intubation, mechanical support, positive pressure ventilation and continous positive airway pressure (CPAP) help in the prevention of alveolar collapse, thereby assisting in lung inflation in patients with atelectasis.

Treatment of atelectasis primarily involves treatment of the underlying cause. Besides this, supportive therapy may be given to patients.

• Chest physiotherapy helps in the clearance of secretions and improvement of cough in patients with atelectasis. It is the initial non-pharmacological intervention of choice preferred in patients. However, it may be contraindicated in patients with trauma to the chest wall or immobilization.
• The various types of chest physiotherapy used in patients include:
  • Huffing: A technique of forced expiration
  • Postural drainage (Lying in the left lateral decubitus position away from the affected side to allow its drainage)
  • Chest wall percussion
• Other non pharmacological therapies used in patients with atelectasis include breathing and coughing exercises, early ambulation, nasotracheal suctioning and fibreoptic bronchoscopy.^[1]
• Obstructive atelectasis due to mucus plugs may be treated with nebulized dornase alfa (DNase) and N-acetylcysteine, which helps in the lysis of mucus secretions. Antitussive therapy is used for the treatment of cough in these patients.
• Resorption atelectasis due to airway obstruction is initially treated with coughing exercises and nasotracheal suctioning. If these interventions fail, fiberoptic bronchoscopy is used to clear the obstruction.^[2]
• Passive and adhesive atelectasis require positive end-expiratory pressure to prevent alveloar collapse.
• Patients with atelectasis have a high chace of developing secondary infection in atelectatic sites. Patients with signs of infection should be administered broad spectrum antibiotics. DNase is also useful for pediatric patients with infectious atelectasis, in the absence of underlying cystic fibrosis.^[3]
• Postoperative atelectasis may be prevented by ensuring judicious use of anaesthetic agents known to cause narcosis. Narcotic use should be kept to a minimum to avoid depression of the cough reflex. Use of epidural analgesia in patients with underlying pulmonary disease is advocated. In addition to this, the use of incentive spirometry, early ambulation, humidifiers, nebulized bronchodilators (Albuterol, Metaproterenol), chest physiotherapy, deep breathing, coughing exercises and supplemental oxygen in order to maintain an arterial oxygen saturation of greater than 90 percent is recommended in patients. Intubation, mechanical support, positive pressure ventilation and CPAP help in the prevention of alveolar collapse, thereby assisting in lung inflation in patients with atelectasis.
• Obstructive atelectasis due to a tumor may be treated using modalities such as surgery, radiation therapy, chemotherapy, or laser therapy.

• Obstructive atelectasis due to mucus plugs
  • Non-pharmacological therapy:
    • Preferred regimen (1): Coughing exercises
    • Preferred regimen (2): Nasotracheal suctioning
    • Preferred regimen (3): Fiberoptic bronchoscopy
  • Pharmacological therapy:
    • Preferred regimen (1): Nebulized dornase alfa (DNase) 2.5 mg nebulizer q24h or q12h
    • Preferred regimen (2): N-acetylcysteine aerosol 5-10 mL of 10% or 20% solution by nebulization q6-8hr
    • Preferred regimen (3): Antitussive therapy
• Postoperative atelectasis
  • Preferred regimen (1): Intubation
  • Preferred regimen (2): Mechanical support
  • Preferred regimen (3): Positive pressure ventilation
  • Preferred regimen (4): CPAP
• Obstructive atelectasis due to a tumor
  • Preferred regimen (1): Surgery
  • Alternative regimen (1): Radiation therapy
  • Alternative regimen (2): Chemotherapy
  • Alternative regimen (3): Laser therapy
• Infectious atelectasis
  • Preferred regimen (1): Cefuroxime 250-500 mg PO q12hr for 10 days
  • Alternative regimen (1): Cefuroxime 500-750 mg IV q8hr; switch to oral therapy
  • Alternative regimen (2): Cefuroxime 250-500 mg PO q12hr for 5-10 days
  • Alternative regimen (3): Cefaclor 250-500 mg PO q8hr
  • Alternative regimen (4): DNase 2.5 mg nebulizer q24h or q12h

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