Further Inpatient Care
- The child with atelectasis should be kept in the hospital while in need of supplemental oxygen and therapy that cannot be adequately or appropriately administered at home.
- Treatment may include antibiotics and chest physical therapy.
- Children with neuromuscular disease may benefit from using a mechanical ex-insufflator, which is often part of their long-term home management.
Further Outpatient Care
- Continued therapy is necessary to attempt to eliminate the atelectasis and to prevent further episodes.
- If the child has asthma, prolonged taper of systemic steroids may help eliminate the airway swelling that predisposed the patient to atelectasis. Inhaled corticosteroids help control the asthma and prevent further episodes. Early recognitions of exacerbations of asthma and early therapy also prevent future problems.
- If the child has cystic fibrosis, see Cystic Fibrosis for a more detailed discussion of the therapy of the disease.
- If the child has neuromuscular disease or an abnormal chest wall, attempts to clear the airways, such as with chest physical therapy and postural drainage, help prevent atelectasis. The mechanical ex-insufflator is very helpful in mobilizing secretions in children with an ineffective cough. Some children benefit from positive pressure ventilation to maintain airway and alveolar patency. This should be performed in conjunction with a pediatric pulmonologist.
- If aspiration due to gastroesophageal reflux or swallowing dysfunction predisposes to atelectasis, these causes should be addressed. Pharmacotherapy of gastroesophageal reflux is available. Speech therapists and occupational therapists can often assist with swallowing dysfunction.
Inpatient & Outpatient Medications
- Therapy should be geared to the underlying disorder whenever possible.
- If the child has asthma, then oral steroids, frequent inhaled bronchodilators, and high-dose inhaled steroids may help the underlying inflammation and bronchospasm. Antibiotics are not necessary.
- If the child has cystic fibrosis, see Cystic Fibrosis for a discussion of appropriate therapy.
Transfer
- Patients should be transferred to a tertiary care facility if they require a level of support that the referring institution is unequipped for or does not frequently perform in children.
Deterrence/Prevention
- The appropriate long-term management of asthma should reduce the likelihood of the child developing atelectasis.
- In children with cystic fibrosis, adequate use of the airway clearance mechanisms, sometimes in conjunction with antibiotics, can reduce the likelihood of atelectasis developing.
- In children with neuromuscular disease, using a mechanical ex-insufflator (CoughAssist Device) can mobilize those secretions that predispose to atelectasis.
- Routine use of chest physical therapy and postural drainage after extubation has not been shown to reduce the incidence of atelectasis.
Complications
- Complications arising from the underlying disorder
- Hypoxemia
- Secondary infection of the atelectatic lung
- Bronchiectasis in the atelectatic portion of a chronically infected lung
Prognosis
- In most cases, the prognosis for the atelectasis is the same as the prognosis for the underlying disorder. If caused by a readily reversible disorder, the atelectasis should be reversible as well.
- In children with significant neuromuscular disease and lower lobe atelectasis, the atelectasis may be very difficult to resolve.
Patient Education
- Educating the patient and the parents about the underlying disorders and the need to prevent complications is crucial.
- For excellent patient education resources, visit eMedicine's Lung and Airway Center and Procedures Center. Also, see eMedicine's patient education articles Collapsed Lung and Bronchoscopy.
Engoren M. Lack of association between atelectasis and fever. Chest. Jan 1995;107(1):81-4. [Medline].
Bilan N, Galehgolab BA, Shoaran M. Medical treatment of lung collapse in children. Pak J Biol Sci. Mar 1 2009;12(5):467-9. [Medline].
[Guideline] National Heart, Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma (EPR-3). [Full Text].
Bagley CE, Gray PH, Tudehope DI, Flenady V, Shearman AD, Lamont A. Routine neonatal postextubation chest physiotherapy: a randomized controlled trial. Journal of Paedtrics & Child Health. November 2005;41:592-7. [Medline].
De Boeck K, Willems T, Van Gysel D. Outcome after right middle lobe syndrome. Chest. Jul 1995;108(1):150-2. [Medline].
Finder J, Birnkrant DJ, Carl J et al. Respiratory care of the patient with Duchenne muscular dystrophy: An official ATS consensus statement. Am J Respir Crit Care Med. 2004;170:456.
Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ. DNAse and atelectasis in non-cystic fibrosis pediatric patients. Critical Care. August 2005;9:351-6. [Medline].
Miske LJ, Hickey EM, Kolb SM, et al. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. Apr 2004;125(4):1406-12. [Medline].
Schindler MB. Treatment of atelectasis: where is the evidence?. Crit Care. Aug 2005;9(4):341-2. [Medline].
Slattery DM, Waltz DA, Denham B, et al. Bronchoscopically administered recombinant human DNase for lobar atelectasis in cystic fibrosis. Pediatr Pulmonol. May 2001;31(5):383-8. [Medline].
Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. Dec 2000;118(6):1801-13. [Medline].
Woodring JH. Determining the cause of pulmonary atelectasis: a comparison of plain radiography and CT. AJR Am J Roentgenol. Apr 1988;150(4):757-63. [Medline].
Wu KH, Lin CF, Huang CJ, Chen CC. Rigid ventilation bronchoscopy under general anesthesia for treatment of pediatric pulmonary atelectasis caused by pneumonia: A review of 33 cases. Int Surg. Sep-Oct 2006;91(5):291-4. [Medline].
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