Atelectasis: Clinical sciences

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Introduction0:00–0:37

Atelectasis is a condition that results in the reversible partial or complete collapse of a lobe of the lung or the entire lung.
Based on the cause, atelectasis can be divided into obstructive and non-obstructive atelectasis. The obstructive type occurs when there is a blockage of an airway, possibly due to a mass like intrathoracic tumors, aspirated foreign bodies, or mucous plugs.
On the other hand, non-obstructive atelectasis can be caused by compression or the loss of surfactant.Alright, when you encounter a patient who presents with signs and symptoms of atelectasis, you should first perform an ABCDE assessment to determine if the patient is stable or unstable.

Unstable patient0:37–3:22

Now, if the patient is unstable, first stabilize their airway, breathing, and circulation. This means that you may need to intubate the patient, establish IV access, and administer IV fluids before continuing with your assessment.
Once these important steps are done, obtain a focused history and physical exam. History might reveal recent major cardiac, thoracic, or abdominal surgery where general anesthesia was used.
The patient may also report a cough with or without sputum production, dyspnea, and chest pain. On physical examination, you might notice altered mental status, tachypnea, and hypoxemia, as well as cyanosis if hypoxemia is severe.
Additionally, the exam might reveal decreased chest expansion, decreased or absent breath sounds, or crackles on auscultation.
With these symptoms suspect respiratory failure due to atelectasis.After examining your patient, you should order an ABG and a chest X-ray.
Now, ABG typically reveals a normal or low partial pressure of carbon dioxide. Sometimes, ABG may show respiratory alkalosis ​​if the patient is taking rapid, shallow breaths.
When it comes to imaging, the X-ray might reveal increased opacification; narrowing of intercostal spaces; shifting of hilar or cardiomediastinal structures toward the affected side and elevation of the diaphragm on the affected side if there’s lobar collapse.
With these findings, you can diagnose respiratory failure due to atelectasis. The next step is to initiate treatment.
This includes giving supplemental oxygen to maintain oxygen saturation greater than 90%. However, if your patient doesn’t improve and isn’t able to maintain oxygen saturations greater than 90%, intubate the patient and initiate mechanical ventilation.
Finally, don’t forget to do additional workup to diagnose and treat any underlying causes that may have contributed to your patient’s atelectasis, such as pneumonia or lung cancer.
Alright, now that unstable patients are taken care of, let’s go back to the ABCDE assessment and talk about stable patients.

Stable patient3:22–4:58

If your patient is stable, your first step is to obtain a focused history and physical examination. Now, history might reveal changes in regular breathing patterns due to recent general anesthesia, as well as major cardiac, thoracic, or abdominal surgery causing post-operative pain and lack of mobility.
One important point that you should keep in mind while evaluating your patient is that they can be completely asymptomatic.
However, if they are symptomatic, patients will typically report a cough with or without sputum production and dyspnea. Another common presenting sign is early postoperative fever.
When it comes to the physical examination, your patient might have hypoxemia, tachypnea, and decreased chest expansion. On auscultation, you might notice decreased or absent breath sounds and crackles.
So, if you see these findings, you should suspect atelectasis. The next step is to order a chest x-ray.
Imaging typically shows signs of atelectasis like increased opacification, displacement of lung fissures, shifting of hilar or cardiomediastinal structures toward the affected side, narrowing of intercostal spaces, or elevation of the diaphragm on the affected side.
Alright now that we’ve talked about signs of atelectasis on imaging, let’s go over obstructive atelectasis. This occurs when something like a foreign body, tumor, or mucus plug physically obstructs the airway.

Obstructive atelectasis4:58–6:36

Now, if imaging shows increased density of the affected lung with volume loss, as well as overinflation of the unaffected lung, you are likely dealing with obstructive atelectasis.
Once you have made your diagnosis, you can start the treatment to help the patient with their current symptoms and prevent the worsening of their condition.
You should encourage your patient to breathe deeply. If they recently had surgery, you may need to increase their pain medications in order to allow them to take deep breaths.
Other techniques include early ambulation after surgery, incentive spirometry, chest physiotherapy, and supplemental oxygen as needed.
In addition, the underlying cause that’s obstructing the airway should be diagnosed and treated appropriately to resolve the atelectasis.
Now, if the patient has only a few secretions, you may attempt continuous positive airway pressure, or CPAP, in order to push open the alveoli and improve gas exchange.
On the flip side, if your patient has copious amounts of sputum, you’ll need to start chest physiotherapy and perform frequent tracheal suctioning if they are intubated.
However, if these measures are not successful, you’ll need to perform a flexible bronchoscopy.Okay, now that the treatment for obstructive atelectasis is complete, let’s take a few steps back and take a look at non-obstructive atelectasis.

Non-obstructive atelectasis6:36–8:03

Here, the most common cause is the patient being unable to take deep breaths. This can be due to pain from chest trauma, or general anesthesia.
Non-obstructive atelectasis can also occur when the lung is compressed by a space-occupying lesion, such as a mass or tumor, as well as due to a pleural effusion or pneumothorax.
On x-ray, in addition to signs of atelectasis, you may see the underlying cause. For instance, tumors may appear as a consolidative mass; while pleural effusion shows as a dependent opacity with blunting of the costophrenic angle; and pneumothorax would show a distinct visceral pleural edge with an absence of lung markings distally.
If you see these findings, you can diagnose non-obstructive atelectasis.Once the diagnosis is made, move on to treatment.
In the case of non-obstructive atelectasis, you should encourage deep breathing and incorporate other techniques, such as incentive spirometry, chest physiotherapy, and supplemental oxygen as needed.
Additionally, be sure to treat the underlying cause, such as tumors or pleural effusion. Alright, as a quick recap… Atelectasis is a condition that results in the partial or complete collapse of a lobe of the lung or the entire lung.

Review8:03–9:04

Unstable patients should be assessed with ABG and chest X-ray, and treated with supplemental oxygen or mechanical ventilation to maintain oxygen saturation above 90%.
Additionally, you need to treat the underlying cause of atelectasis. When it comes to stable patients, they should also be assessed with an X-ray.
Atelectasis should be managed with preventive measures like deep breathing, early ambulation after surgery, pain management, incentive spirometry, chest physiotherapy, supplemental oxygen, and treating the underlying cause.
If the patient has only a few secretions, CPAP is usually enough to deal with those. However, if secretions are copious, they will need chest physiotherapy, tracheal suctioning if intubated,