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At least 253 records · Page 14Linked to original sources
PubMed1978

A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery.

Following cardiac operations, 145 patients were treated with either intermittent positive-pressure breathing (IPPB), blod bottles, or an incentive spirometer in an attempt to alter the incidence of atelectasis. Pulmonary complications occurred in 30% of the patients receiving IPPB, 15% of those using an incentive spirometer, and 8% of those using blow bottles. Gastrointestinal side-effects occurred in 20% of the IPPB group and were rare in other groups. The cost of IPPB is also considerably greater than either incentive spirometry or blow bottles. IPPB is not essential to prevention of atelectasis in postoperative cardiac surgical patients and may be inferior to other methods.

Cardiac Surgical Procedures↗
PubMed2001

[Round atelectasis].

The objective of this study was to analyse the epidemiologic, clinical, radiological and functional characteristics as well as the evolutive pattern of a group of patients diagnosed of round atelectasis (RA). Patients with a radiological diagnosis of RA were retrospectively identified from January 1993 to January 1998. Cases with diagnosis not confirmed by high resolution computerized axial tomography (HRCAT) were excluded. A total of 29 patients were identified, with a mean age of 65 +/- 13 years (27 men and 2 women). At diagnosis 14 patients (34%) were smokers and 14 (49%) ex-smokers. Regarding occupation, 11 individuals (38%) had history of occupational exposure to asbestos. Regarding symptomatology, round atelectasis was a radiological finding in 15 patients (52%) and the most common symptom was chest pain (34%). The most common findings detected in the chest X-ray included pleural thickening (45%), pleural effusion (38%), nodular lesion (34%) and loss of volume (24%). The most common changes detected by HRCAT were pleural thickening (45%) and bronchovascular arch (55%). In two cases magnetic resonance (MR) was performed and in no case did this examination provided additional information for the diagnosis of RA. Functional respiratory examination did not identify and predominant pattern. During the follow-up period (2.2 years) 24 patients (83%) remained radiologically stabilized, one improved and the other four worsened (two due to enlargement and two due to increase in number). Chest X-ray is a good method for the presumptive diagnosis of RA. HRCAT is an excellent technique to confirm the diagnosis and rule out the presence of malignancy. MR provides no additional information in the study of RA. There is a frequent association between RA and asbestos exposure.

Aged↗
PubMed1998

The role of neonatal chest physiotherapy in preventing postextubation atelectasis.

We retrospectively assessed atelectasis in 297 postextubation radiographs from 220 babies who underwent ventilation over a 2-year period. All 95 babies in the first year received peri-extubation chest physiotherapy; none of the 125 babies in the second year received chest physiotherapy. There was no difference in the incidence of postextubation atelectasis between the two groups.

Female↗
PubMed1984

Atelectasis in childhood.

The clinician who identifies atelectasis in a child must determine the mechanism by which atelectasis developed, the functional significance of the collapsed lung, and the etiology responsible for its presence. This article provides a framework to help physicians address these issues and thereby elect the most rational diagnostic and therapeutic interventions at the most appropriate time.

Age Factors↗
PubMed1994

[Rounded nodular atelectasis: computerized tomography and magnetic resonance appearances].

Rounded atelectasis is a rare form of lung collapse whose X-ray appearance can be confused with that of tumors, especially nodular forms. We studied 14 such lesions with computerized tomography, finding that all were rounded and subpleural, specifically in the thickened pleura visceralis. The radiological sign that was most useful for diagnosis was the arc of the proximal vessels in the direction of the lesion. Such an arc was present in all the cases we reviewed. Other radiological signs such as brightness of the surrounding parenchyma, loss of volume in the affected lobe and the presence of air bronchogram were found in 10, 7 and 7 patients, respectively. When the X-ray appearance clearly indicates a diagnosis of rounded nodular atelectasis, we recommend that no additional diagnostic procedure be made. Three lesions in our sample were studied by magnetic resonance, which revealed the characteristic hypointense curves in all sequences done on 2 patients. The usefulness of computerized tomography in the diagnosis of this entity relegates magnetic resonance to a second plane.

Adult↗
PubMed2003

Postoperative atelectasis after one-lung ventilation with the Univent tube in a child.

This case describes a postoperative complication after single-lung ventilation in a 10-year-old patient scheduled for scoliosis repair. This patient underwent an anterior thoracoscopic excision of several vertebral discs followed by a posterior double-rod fixation of her spine. The postoperative course was complicated by complete atelectasis of the patient's right lung for 5 days. Methods of single-lung ventilation, advantages and disadvantages of the Univent tube versus the double-lumen tube, and the possible mechanisms leading to postoperative atelectasis in this child are discussed.

Child↗
PubMed2002

Atelectasis--an unusual and late complication of lung transplant.

We report a previously unrecognized late complication of allograft lung transplantation - persistent recurrent atelectasis of the transplanted lung. The patient developed sudden, severe respiratory distress about 2 yr after a right lung transplant, because of acute atelectasis of her transplanted lung. Multiple transbronchial biopsies at the time revealed minimal inflammation and no evidence of rejection. She was treated with surfactant replacement therapy, and her collapsed lung fully expanded following surfactant installation. To eliminate the possibility of acquired deficiency of surfactant lipids or proteins, ultrastructural examination and immunostains for surfactant proteins were performed in a transbronchial lung biopsy. No deficiency of surfactant lipids or proteins was found. On ultrastructural examination of the lung biopsy, the number of Type II cells per alveolus and the number of lamellar bodies per square micron of Type II cell cross-sectional area was increased compared with an age-matched control. We conclude that synthesis of surfactant lipids and proteins was unimpaired and because of the patient's response to surfactant replacement therapy, that the increase in number of lamellar bodies could reflect a compensatory mechanism for a surfactant functional defect. The patient later developed breast carcinoma to which she succumbed. We raise the possibility that the functional surfactant defect is a hitherto unrecognized non-metastatic manifestation of malignancy.

Female↗
PubMed1999

Pulmonary atelectasis during paediatric anaesthesia: CT scan evaluation and effect of positive endexpiratory pressure (PEEP).

The case series consisted of ten children, ranged in age from one to three years (median 1.8 yrs), and in body weight from 10.2 to 13.5 kg (median 11.7 kg), in ASA class 1 or 2, all without lung disease. Having undergone general anaesthesia for cranial or abdominal CT scans, the patients were studied for pulmonary morphology. The first pulmonary CT scan was taken five min after induction of general inhalational anaesthesia; preoxygenation was avoided and an intraoperative FiO2</=0.4 was used. Densities in dependent regions of both lungs were observed in all children. After ventilation with PEEP of 5 cmH2O, all the observed densities disappeared without impairment of heart rate, blood pressure, haemoglobin saturation and endtidal CO2 (PECO2). We conclude that the appearance in children of atelectasis cannot be explained by a reabsorption of O2 mechanism and by denitrogenation. However, a PEEP of 5 cmH2O is able both to recruit all the available alveolar units, and to induce the disappearance of atelectasis in dependent lung regions.

Anesthesia, Inhalation↗
PubMed1976

[Marginal atelectasis of the lower lobes (author's transl)].

During one year ward films showed opacities with sharp upper margins at the borders of the upper and lower lobes in 17 seriously ill patients, aged between 67 and 87 years. These were interpreted as marginal atelectases of the lower lobes; they have not been previously described. Hypoventilation, with incomplete expansion and marginal atelectasis in seriously ill patients in bed first affect the lower lobes, according to the laws of respiratory physiology and pathology. Marginal atelectasis of the lower lobes occurs unilaterally or bilaterally and in the early stages is reversible. Radiologically, it is clearly distinguishable from intralobar effusions into the major fissure. Other differential diagnosis, such as small pneumothoraces or overlying soft tissue shadows, are not a significant problem.

Aged↗
PubMed1999

Transient marked atelectasis: an unusual complication of asthma in pregnancy.

We present an unusual case in which a patient with asthma presented with acute respiratory distress of acute onset, secondary to marked atelectasis of the right middle and lower lobes, which resolved within 24 hr following administration of increased doses of intravenous steroids, inhalation therapy (beta-agonists and steroids), and pulmonary physiotherapy. This transient occurrence responding to basic therapeutic measures was considered consistent with the release of a mucous plug which had caused the above obstruction and associated symptomatology and radiographic findings. This case illustrates and supports the practice of chest imaging in patients with atypical presentations of asthma and stresses the importance of pulmonary physiotherapy and bronchodilatory therapy as primary therapeutic agents in cases of mucous plug-associated atelectasis.

Adult↗
PubMed1993

[An unconventional use of the laryngeal mask for the therapy of a postoperative atelectasis-induced respiratory insufficiency].

A 90-year-old cardiopulmonary high-risk patient had to undergo a laparatomy due to a perforated ulcus ventriculi. Postoperatively he developed pulmonary insufficiency due to an atelectasis of the upper right pulmonary region. The clinical situation deteriorated because of dyspnoea and exhaustion. Conservative therapy failed. Atelectasis was overcome by a laryngeal mask airway (LMA) inserted without relaxation and anaesthesia. The LMA enabled CPAP-training for 45 minutes added by inflation of the lung up to a peak airway pressure of 22 cm H2O. Problems and risks of this unconventional use are discussed. Reintubation involving the necessity of relaxation and anaesthesia could be avoided by this unconventional use of a LMA. This case report confirms the good tolerance and easy handling of the LMA. It demonstrates a further application of the LMA, which is not only a new device but a new idea of airway management.

Aged↗
PubMed1991

Clinical findings in middle lobe syndrome and other processes of pulmonary shrinkage in children (atelectasis syndrome).

Processes of atelectasis and pulmonary shrinkage are not confined to the right middle lobe. This fact is illustrated by case reports of five of our nine such patients. All cases shared common clinical and morphologic similarities: congenital malformations of the bronchial skeleton, compression, and chronic inflammation produce comparable pulmonary morphology that always includes atelectasis. Atelectasic processes of longer duration require surgical resection; this led to cures in all the authors' patients.

Bronchiectasis↗
PubMed1987

Round atelectasis. Pathologic and pathogenetic features.

Round atelectasis is an uncommon pulmonary condition usually presenting in an asymptomatic individual as a peripheral parenchymal opacity on a chest roentgenogram. Pathologic examination of eight cases revealed localized fibrosis of the visceral pleura overlying the roentgenographic abnormality in all instances. Beneath the region of fibrosis, the pleura showed extensive wrinkling and folding, occasionally with deep invaginations into the pulmonary parenchyma. No discrete mass corresponding to the roentgenographic opacity was identified; however, lung parenchyma adjacent to the fibrotic and folded pleura appeared compressed, and in some cases, showed interstitial fibrosis. These findings support the hypothesis that round atelectasis is due to contraction of a focus of visceral pleural fibrosis that results in buckling of the pleura and collapse of underlying lung parenchyma.

Female↗
PubMed1977

Sodium nitroprusside increases Qs/Qt in dogs with regional atelectasis.

This study investigated the effects of sodium nitroprusside (SNP) on arterial oxygen tension (Pao2), pulmonary shunt (Qs/Qt), and pulmonary vascular resistance (PVR) in the presence of atelectasis of one lung. Ten dogs were anesthetized, their tracheas intubated with a bronchial divider, and their lungs ventilated with IPPB with pure oxygen. Atelectasis of the left lung was produced by occluding the left side of the bronchial divider and ventilating the right lung. SNP was infused to decrease mean arterial blood pressure by 25%. Pao2 decreased from (mean value+/-1 SD) 134+/-75 to 77+/-23 torr (P less than 0.05) with SNP infusion. Qs/Qt increased from 30+/-7.0 to 39+/-6.0% (P less than 0.05), while cardiac output did not change significantly. PVR of the atelectatic lung decreased, while PVR of the ventilated lung was unchanged. The decrease in PVR in the atelectatic lung suggests that SNP decreases Pao2 and increases Qs/Qt by reversing the hypoxic pulmonary vasoconstriction. As a result, during SNP infusion, perfusion of the atelectatic lung was maintained while perfusion of the ventilated lung decreased.

Animals↗
PubMed1989

Mechanical factors do not influence blood flow distribution in atelectasis.

The contribution of mechanical factors to the vascular resistance of the atelectatic lung has been studied in vivo in the anesthetized open-chest dog. When the left lung was ventilated with an hypoxic gas mixture (while the right lung was ventilated with 100% O2), left lung blood flow decreased from 0.99 +/- 0.11 1.min-1 to 0.40 +/- 0.08 1.min-1 due to hypoxic pulmonary vasoconstriction (hypoxic stimulus PSO2 = 36.1 +/- 0.8 mmHg). When the left lung was made atelectatic, blood flow decreased to 0.65 +/- 0.11 1.min-1, consistent with a weaker hypoxic stimulus (PSO2 = 54.0 +/- 3.2 mmHg). With the addition of sodium nitroprusside infused intravenously, left lung blood flow increased to 1.05 +/- 0.14 1.min-1 during atelectasis, and to 0.61 +/- 0.09 1.min-1 during hypoxic ventilation, while flow remained at 0.94 +/- 0.18 1.min-1 during hyperoxic ventilation. When the results were plotted on pressure-flow diagrams, the hyperoxic, hypoxic, and atelectatic lung points fell on the same pressure-flow line in the presence of nitroprusside. It is concluded that hypoxic pulmonary vasoconstriction is the major (but not necessarily only) determinant of increased vascular resistance in the atelectatic lung, and that passive mechanical factors do not measurably affect blood flow distribution during open-chest atelectasis.

Animals↗
PubMed1990

Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery.

Pulmonary oxygen transfer, defined by PaO2/FIO2, and radiologic presence of atelectasis were measured pre-, intra-, and postoperatively to postoperative day 9 in elective cardiac aortocoronary bypass surgical patients, who were randomly allocated either to receive 18 h PEEP while on the ventilator followed by 12 h of nasal continuous positive airway pressure (nasal CPAP) or to be control subjects. The two groups were comparable in age, sex, forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 over forced vital capacity (FVC), time on pump, units of blood transfused, New York Heart Association grading, and cardiac performance indices. The PaO2/FIO2 was significantly (p less than .05) better from half an hour after extubation until 24 h postextubation in the nasal CPAP group, but was decreased for the remainder of the study in both groups. Incidence of atelectasis/consolidation was not different in both groups during the study period. We conclude that nasal CPAP is well tolerated as a treatment of hypoxemia in the immediate postoperative period of aortocoronary bypass patients. CPAP does not change the course of postoperative atelectasis.

Aged↗
PubMed1996

Effects of lobar atelectasis on the distribution of pleural effusion and pneumothorax.

Atelectasis is known to change the retractility of the involved part of the lung and the pleural pressure adjacent to it. Consequently, pleural effusions or pneumothoraxes will change their distribution and preferentially migrate toward the site of atelectasis. This alteration will often result in an atypical distribution of pleural liquid or gas. The radiological implications of this phenomenon are discussed herein.

Humans↗
PubMed1997

Magnetic resonance imaging of rounded atelectasis.

This study describes the magnetic resonance imaging (MRI) findings of rounded atelectasis (RA) and compares them with computed tomography (CT) findings. The study sample comprised 15 cases of RA in which both MRI and CT were performed. The signal intensity of RA was higher than that of muscle and lower than that of fat on T1-weighted images, and similar to or lower than that of fat on T2-weighted images. The atelectatic mass homogeneously enhanced after gadopentetate dimeglumine administration. Structures within and surrounding the RA were clearly depicted on MRI. The pulmonary vessels and bronchi converging toward the area of atelectasis (comet tail sign) were better demonstrated by sagittal or oblique sagittal MRI in six cases. RA and thickened pleurae were more clearly separated on T2-weighted images compared with CT. An infolded visceral pleura was demonstrated as a low-signal-intensity line in seven cases, and a small amount of entrapped pleural effusion was noted in one case. Although MRI should not be performed in all cases of suspected RA, it is useful, especially in delineating the internal structure of RA, such as the infolded visceral pleura.

Contrast Media↗