What is Atelectasis (Atelectasis)?
The term “atelectasis” comes from Greek words meaning “incomplete expansion.” It was first used by a German doctor named Eduard Jörg in 1832. Atelectasis is when small airways in the lungs partially or fully collapse, and this can be reversed. This collapse disrupts the normal exchange of carbon dioxide and oxygen, leading to a scenario where blood passes through the lungs without being properly oxygenated. Atelectasis is particularly common in patients who are under general anesthesia, with rates as high as 90%, highlighting the need for healthcare providers to take this condition seriously.
What Causes Atelectasis (Atelectasis)?
Atelectasis is a condition where lung tissue collapses. This can broadly happen in two ways – obstructive (resorptive) or nonobstructive. Both types can be caused by either increased pressure in the area around the lungs (pleural pressure), low pressure in the small sacs in the lungs (alveoli), or a glitch in a fatty substance in our lungs called surfactant.
Obstructive atelectasis occurs when something blocks the airways, preventing air from reaching the alveoli. Air on the other side of the blockage is absorbed, leading to a collapse of the airways. Things like tumors inside the chest, mucus plugs or odd objects in the airways can cause this condition. Children can be especially affected due to their still-developing airways. On the flip side, adults with a condition called chronic obstructive pulmonary disease (COPD), who have more developed airways, are less likely to experience this. Inhaling a high fraction of pure oxygen can also lead to this condition, as oxygen is absorbed into the blood faster than another gas called nitrogen, causing the alveoli to lose their shape.
Nonobstructive atelectasis, on the other hand, doesn’t happen because of a blockage in the airway. One type of this is compression atelectasis, which is caused by outside pressure on the lung from things like fluid build-up around the lung, a collapsed lung, a swollen abdomen, or tumors. Another type is surfactant-related atelectasis, which happens if the surfactant is damaged, increasing tension and causing the alveoli to collapse. This can be seen in conditions like acute respiratory distress syndrome (ARDS) or neonatal respiratory distress syndrome (RDS).
Other types of atelectasis include cicatrization atelectasis from lung scarring due to conditions like tuberculosis or fibrosis, relaxation atelectasis caused by loss of contact between the lung and chest wall, and replacement atelectasis where tumors replace the alveoli – this is often seen in a type of lung cancer called bronchioalveolar carcinoma.
Some special cases include postoperative atelectasis which can occur within 72 hours of surgery. This type often combines both obstructive and nonobstructive mechanisms. Rounded atelectasis, although less common, is often linked to a lung condition called asbestosis, and involves collapsed lung tissue that folds onto the pleura. Middle lobe syndrome involves repeated or consistent collapsing of specific parts of the lung due to both obstructive and nonobstructive causes.
Risk Factors and Frequency for Atelectasis (Atelectasis)
Atelectasis, a medical condition related to your lungs, can affect anyone regardless of their sex or if they have conditions like COPD or asthma. It’s also not more common in elderly people.
- People who cannot move around and those who are on mechanical ventilation are more likely to develop atelectasis. This includes people who need general anesthesia or those who are in the intensive care unit.
- It’s more often seen after heart surgeries involving a cardiopulmonary bypass than after other surgeries, such as chest surgeries. However, patients who have undergone abdominal and chest procedures have a higher risk of getting atelectasis.
- People with obesity and pregnant women are more prone to atelectasis because they have less functional residual capacity – the amount of air left in your lungs after you breathe out as much as you can.
Signs and Symptoms of Atelectasis (Atelectasis)
Atelectasis is a condition that often has no noticeable effects if only a few alveoli, the tiny air sacs in the lungs, are affected. But as more alveoli become involved, the person might experience rapid, shallow breathing, difficulty breathing, a cough that could produce sputum (mucus), and chest pain that gets worse when inhaling.
The doctor’s physical examination might note the following symptoms:
- Rapid, shallow breathing (tachypnea)
- Increased effort to breathe
- Diminished or no lung sounds
- Rattling sounds in the lung (crackles)
- Reduced expansion of the chest when breathing
Testing for Atelectasis (Atelectasis)
Atelectasis, a condition when a part of the lung collapses or doesn’t inflate properly, is usually identified based on patient’s symptoms and their risk factors. If the doctors need to confirm their suspicion, they rely on multiple imaging techniques like x-rays of the chest, CT scans, or thoracic ultrasound.
A chest x-ray provides a picture of the lung area and can show certain signs indicative of atelectasis, like horizontal lines in the collapsed lung region, cloudy lungs, or the windpipe shifting towards the affected side. However, it’s important to note that these signs may not be clearly visible on standard chest x-rays unless the atelectasis is quite severe.
CT scans of the chest are often conducted in patients with suspected atelectasis. These scans can reveal loss of volume on the affected side of the chest and patches of reliance on the lungs.
If the doctors still need more information, they can use a procedure called fiberoptic bronchoscopy. This procedure includes inserting a small camera into the airways of the lungs and can be helpful in both confirming the diagnosis of atelectasis and identifying the reason behind it, such as mucus plugs, foreign bodies, or tumors.
Finally, a specific blood test, known as an arterial blood gas test, could be done to detect low oxygen levels and changes in the levels of carbon dioxide in the blood, which may suggest the presence of atelectasis. In many cases, the carbon dioxide level in the blood is normal but can decrease if the patient is breathing more rapidly due to atelectasis.
Treatment Options for Atelectasis (Atelectasis)
Atelectasis is a lung condition that can occur during general anesthesia, resulting in temporary lung dysfunction that typically resolves 24 hours after surgery. However, in some cases, it may cause serious breathing difficulties that can lead to further health complications. It’s important to prevent atelectasis, if possible, by avoiding general anesthesia, moving around as soon as possible after surgery, managing pain effectively, and limiting the use of strong opioids. When general anesthesia is necessary, methods such as continuous positive airway pressure, using the smallest amount possible of inhaled oxygen during and after anesthesia, positive end-expiratory pressure (PEEP), lung recruitment maneuvers, and using low volumes of inhaled gas can help prevent atelectasis.
A study discovered that a combination of lung re-expansion techniques and PEEP was effective in preventing atelectasis in patients with severe obesity. This not only prevented lung collapse but also resulted in better oxygen levels in the blood, shorter recovery time after anesthesia, and fewer lung issues after surgery.
One way to decrease atelectasis is to change the patient’s position from lying flat to sitting upright – this increases the volume of functional residual capacity (FRC) and decreases the occurrence of atelectasis. Encouraging patients to take deep breaths, walk around early, use a breathing exercise device, participate in chest physiotherapy, suction the trachea in intubated patients, and use positive pressure ventilation are all ways to decrease atelectasis. These methods work by momentarily increasing the pressure within the lung, allowing the collapsed lung segments to re-expand. Preventative measures, such as using a breathing exercise device, should be taught before surgery and practiced every hour after the procedure until discharge, for maximum benefit.
Treatments to dissolve excessive mucus, like N-acetylcysteine, have been used with limited evidence suggesting they prevent post-surgical atelectasis. However, for certain population groups, including pediatric patients and those with cystic fibrosis, another therapy known as recombinant human dornase alpha could help alleviate atelectasis due to mucus clogging.
Fiberoptic bronchoscopy, a technique where a small camera is inserted into the lungs, is also helpful in managing atelectasis. A study found that bronchoscopy improved lung function and reversed atelectasis in the majority of cases. It should always be considered when there’s a high risk of a blocked bronchus and other techniques haven’t worked. It’s also recommended when other less invasive efforts, such as walking around early after surgery, using a breathing exercise device, and humidity, have not been effective. Preventing atelectasis early and recognizing patients at risk can significantly improve patient outcomes and reduce healthcare costs.
What else can Atelectasis (Atelectasis) be?
When trying to identify the cause of atelectasis, which is a medical term for lung collapse, doctors could consider several possibilities. These may include:
- Tumors or growths in the lung
- Pneumonia, which is an infection in the lungs
- Pleural effusion, which is a buildup of fluid in the lungs
- Pulmonary embolism, which is a blood clot in the lung
- A foreign object that has entered the lung.
The doctor will carefully weigh these possibilities and may order additional tests to ensure the precise cause of atelectasis is determined.
What to expect with Atelectasis (Atelectasis)
The outlook for patients with atelectasis, a condition where the lung’s air sacs collapse, varies significantly. The main factors determining the prognosis are the cause of the atelectasis and the patient’s other health conditions. If atelectasis is not treated, it might lead to lung infections, including repeated cases of pneumonia.
Atelectasis can also result in the inability of the lungs to properly exchange oxygen, leading to low oxygen levels in the blood, known as hypoxemia, causing breathing difficulties. Over time, regular occurrences of atelectasis can lead to lung scarring or fibrosis and reduce overall lung capacity.
Early detection and appropriate treatment are vital to prevent these potentially severe complications.
Possible Complications When Diagnosed with Atelectasis (Atelectasis)
Atelectasis, a common breathing complication that can occur after surgery, can lead to substantial health risks and even death. This is because it can develop into severe conditions like pneumonia and acute respiratory failure.
Recovery from Atelectasis (Atelectasis)
In the past, people believed that lung collapse, or atelectasis, might cause a fever after surgery. But, there’s no scientific evidence to support this idea. A thorough review study by Mavros and his team analysed eight different studies involving 998 patients who had heart, abdominal, or maxillofacial (jaw and face) surgery. They found a weak link between atelectasis and fever shortly after surgery. However, the results from these different studies were quite mixed, so we need more large-scale studies to get a clearer picture.
Preventing Atelectasis (Atelectasis)
Atelectasis is a term used to describe a partial collapse of the lung, which can leave people feeling short of breath. This condition can be triggered by several factors – weak breathing effort, blockages that prevent air from reaching the lungs, excess pressure on the outer part of the lung, or problems with a specific protein in the lung. To treat it, doctors primarily use supportive efforts, such as deep breath exercises, breathing incentive tools, and additional oxygen.
People feeling short of breath must immediately seek medical help. It’s worth noting that atelectasis is a common issue after a surgery. Doing deep breath exercises and using aids for loosening and clearing mucous can assist in expanding the lungs and enhancing breathing. Cigarette smoking can damage the lungs, so individuals must be notified to not smoke as it assists in healing the lungs.