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Atelectasis

Definition

Atelectasis is a medical condition, in which the lung tissue collapses, affecting all or just a part of the lung. Due to these changes, the regular absorption of the oxygen into the tissues might be affected. What happens is that the tiny air sacs or alveoli become deflated due to the various reasons. Atelectasis can be acute or chronic.


Atelectasis Symptoms

These are the symptoms that patients diagnosed with atelectasis present:

  • Coughing (mild, not intense)
  • Pain in the chest (not in all patients) – the patients describe the pain as stabbing
  • The patient can have difficulties breathing (the breathing is shallow and rapid)
  • The saturation of the oxygen is low
  • Pleural effusion can occur (accumulation of fluid in the pleural cavity)
  • Cyanosis (appears as a late sign, in those who are suffering from chronic forms)
  • The heart rate can be increased; due to the transportation of the oxygen being affected, the heart pumps more blood, trying to compensate
  • The patient can also have an increased temperature (this is not caused by the atelectasis but appears as a side symptom, due to the infection)
  • Decreased expansion of the chest wall
  • Paleness of the skin can occur in case a large area of the lung is affected

Causes

These are the causes that lead to the appearance of atelectasis:

  • Surgical intervention
    • Atelectasis appears as a post-surgical complication
    • This is a risk for those who have undergone chest or abdominal surgery (shallow breathing due to the pain inflicted by the surgical incision)
    • Increased risk for smokers or those who are older
  • Inhaled foreign body/mucus plug at the level of bronchiole/bronchus (blockage)
  • Cancer (squamous cell carcinoma)
  • Compression of the lungs, caused by:
    • Tumors outside the lungs
    • Swollen lymph nodes
    • Tubercles
  • Surfactant deficiency – the surfactant spreads poorly during inspiration (the tension leads to the collapse of alveoli that are smaller in size)
  • Suction – during the process, apart from the sputum, air is withdrawn from the lungs, which can lead to the collapse of the alveoli
  • Other causes
    • Cystic fibrosis
    • Fluid in the lungs
    • Respiratory weakness
    • Chest injuries (fractured ribs)
    • Prematurity – in premature born babies, this condition can lead to the infant respiratory distress syndrome
    • Insufficient attempts at respiration (newborn)

Diagnosis

These are the most common methods used for the diagnosis of atelectasis:

  • Physical examination
    • Record the symptoms of the patient
    • Auscultation – the doctor listens to the lungs of the patient through a stethoscope
      • Through this examination, the doctor can identify diminished bronchial sounds
    • Percussion – the doctor taps on the chest, while using the stethoscope to listen
      • Percussion is used to identify how much of the lung has collapsed
  • Medical imaging
    • Chest X-ray
      • If an airless area is present in any of the lungs, this can confirm the diagnosis of atelectasis
    • CT scan
      • Recommended in patients who might suffer from a blockage of the airways
  • Bronchoscopy
    • This can be used in order to identify the cause of the blockage, at the level of the airways
  • Oximetry
    • Measure the saturation of the oxygen in the blood

Treatment

These are the treatment solutions recommended for patients diagnosed with atelectasis:

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  • Physiotherapy – the physical therapy exercise program is meant to teach the patient how to breathe deeply and cough, in order to eliminate the excess mucus
  • Incentive spirometer – used for the breathing exercises
  • Ambulation – improve the inflation of the lungs
  • Mechanical devices to assist the breathing process – these are used in patients who suffer from deformities at the level of the chest or in those who have been diagnosed with neurologic conditions (shallow breathing for prolonged periods of time)
  • Continuous positive airway pressure – oxygen is delivered through a special mask, in order to avoid the collapse of the lung
  • Mechanical ventilator – provides additional respiratory support
  • Removal of the blockage
    • Coughing
    • Suctioning of the airways
    • Bronchoscopy
  • Antibiotics – standard treatment for bacterial infections
  • Surgical removal of the affected part of the lung – recommended in patients who suffer from recurring infections, affecting their overall quality of life or in those where the bleeding is significant
  • Surgical removal of the tumor causing pressure on the alveoli
  • Other treatments for cancerous growths – radiation therapy, chemotherapy, laser therapy

Prevention

Children are often at high risk of inhaling foreign objects, which can lead to a blockage of their airways. In order to prevent such things from happening and also to reduce the risk of atelectasis, you should always keep your eyes on the children and make sure that the small objects are out of reach.

For those who have suffered a surgical intervention, atelectasis can be prevented by the frequent changes of positioning in bed and by performing daily exercises (deep breathing and coughing). The usage of breathing devices, such as the incentive spirometer, might also prevent atelectasis. This condition can also be prevented by quitting smoking, with at least a couple of weeks before the surgical intervention. After the surgery, you can prevent this condition, by increasing the fluid intake (keep the lung secretions loose and prevent the formation of mucus plugs). You might also prevent atelectasis by increasing the level of humidity in the room (use a room humidifier). Postural drainage in case of a respiratory illness can prevent the appearance of complications, such as atelectasis.

Complications

These are the complications that can occur with atelectasis:

  • Hypoxia – the low levels of oxygen in the blood are due to the pulmonary alveoli being collapsed
  • Pneumonia – if a lot of mucus builds up in the collapsed lung, there is a high risk of infection
  • Respiratory failure – the risk for such complications is increased in those who are suffering from chronic conditions (such as cancer or severe respiratory disease) or those whose immune system is not so strong (elderly patients, newborns)

Atelectasis vs Pneumothorax

As it was already mentioned, atelectasis concerns the collapsing of the lung alveoli, affecting a larger or a smaller portion of the lungs. Pneumothorax, on the other hand, is a medical condition in which air or gas collects in the pleural space. This may lead to the collapse of the lungs, interfering with normal breathing. Pneumothorax is considered a medical emergency and, without immediate intervention, it can lead to death due to respiratory failure.

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