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PubMed1998

Use of a vital capacity maneuver to prevent atelectasis after cardiopulmonary bypass: an experimental study.

BACKGROUND: Respiratory failure secondary to cardiopulmonary bypass (CPB) remains a major complication after cardiac surgery. The authors previously found that the increase in intrapulmonary shunt was well correlated with the amount of atelectasis. They tested the hypothesis that post-CPB atelectasis can be prevented by a vital capacity maneuver (VCM) performed before termination of the bypass. METHODS: Eighteen pigs received standard hypothermic CPB (no ventilation during bypass). The VCM was performed in two groups and consisted of inflating the lungs during 15 s to 40 cmH2O at the end of the bypass. In one group, the inspired oxygen fraction (FIO2) was then increased to 1.0. In the second group, the FIO2 was left at 0.4. In the third group, no VCM was performed (control group). Ventilation-perfusion distribution was measured with the inert gas technique and atelectasis by computed tomographic scanning. RESULTS: Intrapulmonary shunt increased after bypass in the control group (from 4.9 +/- 4% to 20.8 +/- 11.7%; P < 0.05) and was also increased in the vital capacity group ventilated with 100% oxygen (from 2.2 +/- 1.3% to 6.9 +/- 2.9%; P < 0.01) but was unaffected in the vital capacity group ventilated with 40% oxygen. The control pigs showed extensive atelectasis (21.3 +/- 15.8% of total lung area), which was significantly larger (P < 0.01) than the proportion of atelectasis found in the two vital capacity groups (5.7 +/- 5.7% for the vital capacity group ventilated with 100% oxygen and 2.3 +/- 2.1% for the vital capacity group ventilated with 40% oxygen. CONCLUSION: In this pig model, postcardiopulmonary bypass atelectasis was effectively prevented by a VCM.

Animals↗
PubMed2005

Pulmonary atelectasis: a pathogenic perioperative entity.

Atelectasis occurs in the dependent parts of the lungs of most patients who are anesthetized. Development of atelectasis is associated with decreased lung compliance, impairment of oxygenation, increased pulmonary vascular resistance, and development of lung injury. The adverse effects of atelectasis persist into the postoperative period and can impact patient recovery. This review article focuses on the causes, nature, and diagnosis of atelectasis. The authors discuss the effects and implications of atelectasis in the perioperative period and illustrate how preventive measures may impact outcome. In addition, they examine the impact of atelectasis and its prevention in acute lung injury.

Aging↗
PubMed1980

Atelectasis associated with mechanical ventilation for hyaline membrane disease.

The occurrence of atelectasis among infants, who were intubated and mechanically ventilated for hyaline membrane disease and who survived the neonatal period, was examined after omitting atelectasis associated with obvious malposition of the endotracheal tube. Atelectasis occurred both while intubated and after extubation. There was a pronounced effect of birth weight. The incidence among 131 surviving infants increased from 9% while intubated and 15% after extubation in infants with birth weights > 2000 g to 50% while intubated and 56% after extubation in those with birth weights < 1000 g. Although in general, the incidence fell as the duration of intubation diminished, postextubation atelectasis was a problem even in larger infants with comparatively short intubations. The pattern of atelectasis showed a disproportionate involvement of all lobes of the right lung, both while intubated and after extubation. This suggests that the incidence of atelectasis might be lowered by minimizing traumatic damage to the mucosa of the right sided bronchi.

Birth Weight↗
PubMed1992

Atelectasis and lung function in the postoperative period.

Thirteen patients with healthy hearts and lungs, and with a mean age of 68 years, who were scheduled for lower abdominal surgery during isoflurane anaesthesia with muscular paralysis, were investigated with arterial blood gases, spirometry, pulmonary x-ray and computed tomography (CT) of the chest before and during anaesthesia, as well as during the first 4 postoperative days. Before anaesthesia, lung function and gas exchange were normal in all patients. Pulmonary x-ray and CT scans of the lungs were also normal. During anaesthesia, 6 of 13 patients developed atelectasis (mean 1.0% of intrathoracic transverse area in all patients). Two hours postoperatively, 11 of 13 patients had atelectasis and the mean atelectatic area was 1.8%. Pao2 was significantly reduced by 2.1 kPa to 9.8 kPa. On the first postoperative day, the mean atelectasis was unaltered (1.8%). None of the atelectasis found on CT scanning could be detected on standard pulmonary x-ray. Forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) were significantly decreased to 2/3 of preoperative level. Pao2 was significantly reduced to less than 80% of the preoperative level (mean 9.4 kPa). There were significant correlations between the atelectatic area and the impairment in FVC, FEV1, and Pao2. Spirometry and blood gases improved during the succeeding postoperative days, and atelectasis decreased. No patient suffered from pulmonary complications, as judged from clinical criteria and pulmonary x-ray, in contrast to the findings of atelectasis in 85% of the patients by computed tomography.

Abdomen↗
PubMed1985

Relation of prostanoids to strength of hypoxic vasoconstriction in dogs with lobar atelectasis.

In dogs with acute lobar atelectasis, meclofenamate administration decreases shunt fraction uniformly and moderately without abolishing the wide variation of strength of hypoxic vasoconstriction and resultant variability of shunt fraction (J. Appl. Physiol. 54: 284-289, 1983). To further assess the role of prostanoids, we measured prostanoid metabolites as well as shunt fraction and pressor response to alveolar hypoxia. In six intact anesthetized dogs with acute left lower lobe atelectasis, shunt fraction during normoxia was measured with SF6. Levels of 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) and thromboxane B2 in arterial, mixed venous, and left lower lobe venous blood were measured with the double antibody radioimmunoassay technique. Ten percent O2 was administered to assess pressor response. Twenty-one percent O2 was restarted, meclofenamate was administered, and measurements were repeated 30 min later. Atelectasis did not elevate levels of prostanoid metabolites. 6-Keto-PGF1 alpha averaged 88 +/- 65 pg/ml prior to atelectasis and 81 +/- 73 pg/ml after atelectasis (F = 0.7, P = NS). Likewise, thromboxane B2 values were normal. No transpulmonary concentration differences were found. 6-Keto-PGF1 alpha did not correlate with shunt values, which ranged from 14 to 35% (mean 21%). Meclofenamate effectively blocked cyclooxygenase, as demonstrated by decreases in prostanoid metabolite levels. It seems likely that in dogs with acute atelectasis prostacyclin localized in the pulmonary vasculature decreases strength of hypoxic vasoconstriction modestly and uniformly without raising blood levels of prostacyclin metabolite.

6-Ketoprostaglandin F1 alpha↗
PubMed2005

Treatment of atelectasis: where is the evidence?

Lobar atelectasis is a common problem caused by a variety of mechanisms including resorption atelectasis due to airway obstruction, passive atelectasis from hypoventilation, compressive atelectsis from abdominal distension and adhesive atelectasis due to increased surface tension. However, evidence-based studies on the management of lobar atelectasis are lacking. Examination of air-bronchograms on a chest radiograph may be helpful to determine whether proximal or distal airway obstruction is involved. Chest physiotherapy, nebulised DNase and possibly fibreoptic bronchoscopy might be helpful in patients with mucous plugging of the airways. In passive and adhesive atelectasis, positive end-expiratory pressure might be a useful adjunct to treatment.

Bronchodilator Agents↗
PubMed2003

Prevention of atelectasis formation during induction of general anesthesia.

UNLABELLED: General anesthesia promotes atelectasis formation, which is augmented by administration of large oxygen concentrations. We studied the efficacy of positive end-expiratory pressure (PEEP) application during the induction of general anesthesia (fraction of inspired oxygen [FIO(2)] 1.0) to prevent atelectasis. Sixteen adult patients were randomly assigned to one of two groups. Both groups breathed 100% O(2) for 5 min and, after a general anesthesia induction, mechanical ventilation via a face mask with a FIO(2) of 1.0 for another 5 min before endotracheal intubation. Patients in the first group (PEEP group) had continuous positive airway pressure (CPAP) (6 cm H(2)O) and mechanical ventilation via a face mask with a PEEP of 6 cm H(2)O. No CPAP or PEEP was applied in the control group. Atelectasis, determined by computed radiograph tomography, and analysis of blood gases were measured twice: before the beginning of anesthesia and directly after the intubation. There was no difference between groups before the anesthesia induction. After endotracheal intubation, patients in the control group showed an increase of the mean area of atelectasis from 0.8% +/- 0.9% to 4.1% +/- 2.0% (P = 0.0002), whereas the patients of the PEEP group showed no change (0.5% +/- 0.6% versus 0.4% +/- 0.7%). After the intubation with a FIO(2) of 1.0, PaO(2) was significantly higher in the PEEP group than in the control (591 +/- 54 mm Hg versus 457 +/- 99 mm Hg; P = 0.005). Atelectasis formation is prevented by application of PEEP during the anesthesia induction despite the use of large oxygen concentrations, resulting in improved oxygenation. IMPLICATIONS: Application of positive end-expiratory pressure during the induction of general anesthesia prevents atelectasis formation. Furthermore, it improves oxygenation and probably increases the margin of safety before intubation. Therefore, this technique should be considered for all anesthesia induction, at least in patients at risk of difficult airway management during the anesthesia induction.

Adolescent↗
PubMed2004

Continuous positive airway pressure versus noninvasive pressure support ventilation to treat atelectasis after cardiac surgery.

Atelectasis is common after cardiac surgery and may result in impaired gas exchange. Continuous positive airway pressure (CPAP) is often used to prevent or treat postoperative atelectasis. We hypothesized that noninvasive pressure support ventilation (NIPSV) by increasing tidal volume could improve the evolution of atelectasis more than CPAP. One-hundred-fifty patients admitted to our surgical intensive care unit (SICU) with a Radiological Atelectasis Score >or=2 after cardiac surgery were randomly assigned to receive either CPAP or NIPSV four times a day for 30 min. Positive end-expiratory pressure was set at 5 cm H(2)O in both groups. In the NIPSV group, pressure support was set to provide a tidal volume of 8-10 mL/kg. At SICU discharge, we observed an improvement of the Radiological Atelectasis Score in 60% of the patients with NIPSV versus 40% of those receiving CPAP (P = 0.02). There was no difference in oxygenation (Pao(2)/fraction of inspired oxygen at SICU discharge: 280 +/- 38 in the CPAP group versus 301 +/- 40 in the NIPSV group), pulmonary function tests, or length of stay. Minor complications, such as gastric distensions, were similar in the two groups. NIPSV was superior to CPAP regarding the improvement of atelectasis based on radiological score but did not confer any additional clinical benefit, raising the question of its usefulness for altering outcome.

Aged↗
PubMed1993

Round atelectasis and Metsovo lung.

Round (helical) atelectasis is one of the benign sequelae of occupational asbestos exposure. Environmental asbestos exposure does not differ from occupational in its pleural manifestations, but to our knowledge, round atelectasis has not been reported yet. In the present study, we present the clinical and radiologic findings of five individuals with round atelectasis. They were all born in the Metsovo area, northwest Greece, where environmental exposure to asbestos (tremolite) has been documented. All five had negative evaluation for malignancy. In addition, they have been followed up for one to four years and four of them are in good health, thus confirming round atelectasis as a benign, nonpremalignant condition. The fifth patient died of malignant pleural mesothelioma two years later, while the previously detected round atelectasis remained unchanged. We therefore consider that his mesothelioma was not related to the round atelectasis, although both were certainly related to the same environmental asbestos exposure.

Aged↗
PubMed1997

Is atelectasis following aortocoronary bypass related to temperature?

OBJECTIVE: To determine the frequency of acute postoperative atelectasis in patients undergoing aortocoronary bypass with either normothermic (warm) or hypothermic (cold) technique. DESIGN: Prospective, randomized study comparing two groups. SETTING: University-affiliated hospital. PATIENTS: Three hundred thirty-one patients (166 cold and 165 warm) undergoing isolated aortocoronary bypass. MEASUREMENTS: Chest radiographs were obtained preoperatively, on the day of surgery, and subsequently as clinically indicated until discharge from the hospital. Radiologist (blinded to the patient allocation into warm or cold group) scored the atelectasis from 0 to 3 based on its severity. Regression analysis was used to determine if there was any difference in the atelectasis scores between the two groups. RESULTS: Mean daily postoperative atelectasis scores were not different between the cold and warm groups. The number of patients requiring chest radiographs was similar in both groups. The percent of patients with abnormal chest radiographs was similar in both groups. CONCLUSION: The temperature of cardioplegia has no effect on the development of atelectasis following aortocoronary bypass, and therefore temperature-related cold injury is not a major cause of atelectasis following this type of surgery.

Body Temperature↗
PubMed2003

The use of selective bronchography in predicting reversal of neoplastic obstructive atelectasis.

OBJECTIVES: To assess the ability of selective bronchography to predict which patients with neoplastic postobstructive atelectasis will respond to interventional therapies directed at the reexpansion of the affected lung. Furthermore, to compare the utility of selective bronchography with the current predictive standard that reversal of postobstructive atelectasis is unlikely when it is > or = 4 weeks in duration (ie, the 4-week rule). DESIGN: A prospective observational study. SETTING: A tertiary care referral center/medical school. PATIENTS: Twenty-seven consecutive patients with advanced lung cancer or other malignancy, with documented neoplastic postobstructive atelectasis involving a total of 44 lobes. INTERVENTIONS: Lobar collapse was documented radiographically. The duration of atelectasis was investigated and quantified as accurately as possible. Prior to the use of interventional therapies, selective bronchography was performed on each collapsed lobe, and the results were documented. Bronchography results did not influence the decision to proceed with interventional therapies. Patients had each of their collapsed lobes manipulated by interventional techniques that were directed at reexpansion of the lung. One week after the patient underwent the intervention, the degree of reexpansion was assessed radiographically. RESULTS: Interventional therapies leading to significant reversal of airway narrowing were completed in all 44 lobes. These were successful in reexpanding 28 of 44 collapsed lobes (64%). Selective bronchography demonstrated the following two distinct patterns: an intact bronchial tree (ie, tree pattern); or the absence of a distinguishable, distal bronchial tree (ie, blush pattern). The sensitivity of selective bronchography to predict reexpansion is 1.00 (95% confidence interval [CI], 0.90 to 1.00), and its specificity is 0.56 (95% CI, 0.30 to 0.80). There were no complications attributable to selective bronchography. The sensitivity of the 4-week rule to predict reexpansion is 0.61 (95% CI, 0.41 to 0.78), and its specificity is 0.75 (95% CI, 0.48 to 0.93). The results of selective bronchography and use of the 4-week rule were significantly different in predicting which lobes would reexpand and which would not (p = 0.0026). Using selective bronchography to predict the reversal of lobar atelectasis, the positive predictive value of the tree pattern was 0.80 and the negative predictive value of the blush pattern was 1.00. The values for the 4-week rule are 0.81 and 0.52, respectively. CONCLUSIONS: Selective bronchography is a useful tool for predicting whether patients with neoplastic postobstructive atelectasis would benefit from interventional techniques that are directed at lobar reexpansion. Selective bronchography appears to be superior to the 4-week rule in this regard.

Aged↗
PubMed1988

Determining the cause of pulmonary atelectasis: a comparison of plain radiography and CT.

In a retrospective analysis of 50 patients with segmental or lobar atelectasis of the lung, chest radiographs and CT studies were compared for their abilities to distinguish whether a centrally obstructing tumor was the cause. This was done to help define the role of CT in evaluating patients with atelectasis. Atelectasis was caused by an obstructing tumor in 27 cases and a variety of other conditions in 23. The chest radiograph correctly identified an obstructing tumor as the cause of atelectasis in 24 of 27 patients on the basis of the presence of a central hilar mass or obvious bronchial abnormality; there was 89% sensitivity and 96% specificity with a 12% false-negative rate and a 4% false-positive rate. CT correctly identified all 27 obstructing carcinomas on the basis of the presence of either a central bronchial abnormality or a central hilar mass; there was 100% sensitivity and 87% specificity with a 0% false-negative rate and a 10% false-positive rate. Absence of air bronchograms or the presence of mucus-filled bronchi within the atelectatic lung were secondary CT findings that also favored the presence of an obstructing tumor. Although the chest radiograph was more specific than CT for tumor as the cause of atelectasis (96% vs 87%, respectively), it was less sensitive than CT for tumor (89% vs 100%, respectively) resulting in missed tumor diagnoses. CT identified all cases caused by obstructing tumor and successfully excluded obstructing tumor in most of the remaining cases, with an acceptable number of false-positive tumor diagnoses (10%). CT should be performed when the cause of segmental or lobar atelectasis cannot be established with certainty on the basis of the chest radiograph.

Bronchial Neoplasms↗
PubMed1994

Combined lobar atelectasis of the right lung: imaging findings.

Combined lobar atelectasis refers to the condition in which the volumes of two lobes of the lung are decreased simultaneously. Because the right lung has three lobes, three combinations of combined atelectasis are possible. The most frequent combination is that of middle and lower lobar atelectasis caused by obstruction of the bronchus intermedius [1,2]. Combined atelectasis of the upper and middle lobes is uncommon, although it occurs more frequently than anticipated [1]. The least common combination is that of right upper and lower lobe atelectasis. Awareness of the radiographic and CT findings of combined lobar atelectasis of the right lung is important in making the correct diagnosis. In this pictorial essay, we illustrate the spectrum of radiographic and CT features of this condition.

Adult↗
PubMed1998

Atelectasis in children.

BACKGROUND: In children with lower respiratory tract symptoms, the elicited signs are not enough to distinguish common diagnosis like pneumonic consolidation, foreign body aspiration and atelectasis. Radiology and bronchoscopy would identify the true nature of the etiology. DESIGN: Prospective study. SUBJECTS: Thirty five children with both acute and chronic lower respiratory tract symptomatology, were analyzed for clinical and radiological signs of atelectasis. RESULTS: There were 23 cases in the acute group and 12 in chronic group. Acute group included cases of pneumonia, foreign body aspiration and mucus plug syndrome. Chronic group included cases of congenital heart disease, endobronchial tuberculosis and bronchial stenosis. Clinical recognition of atelectasis on the basis of localized loss of breath sounds and mediastinal shift was seen only in a minority of cases (8/35). The presence of atelectasis in children with pneumonia, missed clinically were diagnosed by the presence of tracheal shift, elevated hemidiaphragm and silhouette sign. In 21 cases, silhouette sign was positive making it an important radiological sign. Twenty one children underwent either diagnostic or/and therapeutic bronchoscopy. Findings included foreign bodies (n = 5), mucus plugs (n = 4), narrowing of main bronchus (n = 4) and inflammatory mucoid secretions and narrowing of lumen (n = 8). There were no major complications. CONCLUSION: The diagnosis of atelectasis in children may pose difficulties and there is a need to have a high index of suspicion to exclude atelectasis in children with either acute or chronic respiratory tract symptomatology.

Acute Disease↗
PubMedDate not supplied

The effect of positioning on arterial oxygenation in children with atelectasis after cardiac surgery.

OBJECTIVE: To determine the effect of body position on arterial oxygenation in children with unilateral atelectasis after cardiac surgery. DESIGN: Prospective, quasi-experimental, random assignment. SETTING: Midwestern university-affiliated tertiary pediatric medical center. PATIENTS: 25 children who underwent cardiac surgery and who presented with unilateral atelectasis within 2 weeks of operation. Age range was one month to 10 years (mean 34 months). OUTCOME MEASURES: The partial pressure of oxygen. INTERVENTION: Data collection was initiated within 24 hours of the diagnosed unilateral atelectasis. Arterial blood gases were drawn from intraarterial lines after subjects were placed for 15 minutes in the supine, right lateral, and left lateral decubitus positions (atelectatic lung dependent or nondependent), the order being randomized. RESULTS: Analysis of variance for repeated measures was used in the data analysis. The mean PaO2 for the supine, nondependent, and dependent positions were 115, 118, and 112, respectively. No statistical differences at p less than 0.05 level of significance were demonstrated for the body positions under study. Age and degree of atelectasis were analyzed as covariates to determine the possible correlation with the PaO2 and the change in PaO2. Age inversely correlated with the PaO2, r = -0.24 (p less than 0.05), indicating the older subjects had a lower PaO2. The degree of atelectasis demonstrated correlation with the change in PaO2, r = -0.26 (p less than 0.05) indicating the subjects with greater degree of atelectasis had a lesser change in PaO2. CONCLUSIONS: These results differ from similar studies on the effect of positioning in adult subjects. This finding suggests that the effect of positioning of children who have had cardiac surgery should be evaluated on an individual basis with close monitoring for changes in clinical condition and oxygen saturation and periodic arterial oxygen blood sampling until further studies can provide conclusive direction.

Age Factors↗
PubMed2003

[Role of flexible bronchoscopy in the treatment of infection-associated atelectasis in children].

OBJECTIVE: Infection-associated atelectasis is rather common during childhood and the effects of drug therapy are often unsatisfactory. The present study aimed to evaluate the effectiveness of flexible bronchoscopy in the treatment of infection-associated atelectasis in children. METHODS: One hundred and twenty-five patients (68 male and 57 female; age ranged from 10 d to 14 years and their courses of disease were from 3 d to 2.5 years) with infection-associated atelectasis confirmed by chest X-ray or CT were enrolled in the study. The following conditions were excluded by bronchoscopy: airway foreign body, airway anomalies, tumor, tuberculosis. The patients were divided into two groups: flexible bronchoscopy group and medication group. In the flexible bronchoscopy group, 65 patients were treated mainly with flexible bronchoscopy whereas in medication 60 group patients only received medication. Chest X-ray or CT was regularly reviewed for every patient, meanwhile the effect of flexible bronchoscopy at different courses of disease was observed. RESULTS: Flexible bronchoscopy group and medication group had no significant differences in age, sex and course of disease (P > 0.05). In flexible bronchoscopy group 39 patients were cured, 20 were improved and 6 cases had no change; in medication group 17 patients were cured, 25 were improved and 18 had no change. The two groups had significant differences (P < 0.01); in bronchoscopy group there were significant differences among patients with the courses of disease less than 3 months, 3 to 6 months and more than 6 months. CONCLUSIONS: The authors concluded that flexible bronchoscopy was an effective method for treatment of infection-associated atelectasis. Flexible bronchoscopy can reach pathological part and clear pus and granulation. It can remove obstruction and relieve symptoms. When course of disease was short, bronchoscopic therapy was advantageous to recovery of atelectasis. Bronchial washing may overcome the shortcomings of bronchoalveolar lavage, therefore the former seemed to be more suitable for treatment of infection-associated atelectasis.

Adolescent↗
PubMed2004

[Etiology and bronchofiberscopic treatment of pulmonary atelectasis in patients with severe motor and intellectual disabilities].

Atelectasis is a common respiratory complication in patients with severe motor and intellectual disabilities. We encountered 3 patients with irreversible atelectasis due to delayed therapy, emphasizing the necessity of performing flexible bronchofiberscopy. A total of 21 patients with atelectasis were studied to assess the etiology and efficacy of bronchofiberscopy. The underlying condition was bronchitis/pneumonia in 19 cases, tracheal hemorrhage in 1, and lung cancer in 1. Most of the patients had predisposing factors, such as a bedridden status in 90% and a weak or absent cough reflex in 81%. It was statistically suggested that atelectasis is likely to occur on the side contralateral to thoracic scoliosis. Among the 18 patients who underwent bronchofiberscopy within 2 weeks after the diagnosis of atelectasis, 16 (89%) showed recanalization and resultant improvement of respiratory failure. Bronchofiberscopy is useful for treating atelectasis in patients with severe motor and intellectual disabilities.

Adolescent↗
PubMedDate not supplied

Evaluation of chronic atelectasis in children using chest computed tomography and bronchoscopy.

A heterogeneous group of 11 children with atelectasis persisting longer than one month were investigated for the causes using chest computed tomography and fiberoptic bronchoscope. Four young infants had right upper lobe (RUL) posterior segmental atelectasis simulating RUL lobar collapse in plain chest films; all had only two visible segmental bronchi by bronchoscopic examination. Intraluminal obstruction in the central airway was not a common cause of pediatric chronic atelectasis in this small series of patients. Only one obstructive atelectasis caused by dilated pulmonary arteries was detected in this study. Two patients with pre-existing neuromuscular diseases showed multiple atelectasis. The atelectatic lobes do not spontaneously re-inflate following flexible bronchoscopy. Investigations involving a larger number of cases are needed to substantiate the etiologies and to guide specific therapy for those children with chronic atelectasis.

Bronchoscopy↗