Pulmonary Atelectasis Treatment & Management

  • Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Jul 22, 2011
 

Medical Care

  • Antibiotics are not necessary in the child with asthma. Oral corticosteroids, together with frequent inhaled bronchodilators and continued high-dose inhaled corticosteroids, address the underlying inflammation and bronchospasm.
  • A recent study determined that noninvasive medical treatment can be simply and easily used to substitute bronchoscopic treatment in small hospitals.[2]
  • If the child with atelectasis has cystic fibrosis, aggressive antibiotic therapy is indicated in conjunction with chest physical therapy and postural drainage. A mucous plug from other causes may respond to chest physical therapy and postural drainage. See Cystic Fibrosis for a more detailed discussion of the therapy for this disorder. Instillation of DNAse, either through a nebulizer or through a bronchoscope, may help remove the secretions more rapidly and completely.
  • Children with neuromuscular disease, children who have undergone surgery, and children with chest pain benefit from chest physical therapy to reduce the likelihood of developing further atelectasis; whether these procedures treat the existing atelectasis is not clear. In children with neuromuscular disease, the mechanical ex-insufflator (CoughAssist Device) is helpful in preventing atelectasis and produces enough of a cough to adequately clear the airways.
  • If pain is causing the atelectasis, adequate pain therapy is mandatory. Administering adequate pain therapy is probably more important than the possibility of decreased minute ventilation from the pain therapy in this situation.
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Surgical Care

  • If the patient is severely affected by the atelectasis and response to therapy of the underlying disorder is suboptimal, bronchoscopic removal of secretions, mucous plugs, or both may be helpful. Both N- acetyl cysteine and rhDNase have been used with some success in facilitating the removal of mucous plugs in the airways. Both have been used in patients with cystic fibrosis and have had some success in patients without cystic fibrosis as well.
  • DNAse has been used in cystic fibrosis to facilitate transport of the abnormal secretions. DNAse has been successfully used in other patients with acute atelectasis. However, the success of the medication depends on the amount of DNA in the secretions, which is generally not known beforehand. Although N -acetyl cysteine has been used as a mucolytic both in nebulizer and bronchoscope forms, success has not been validated in controlled studies. Furthermore, it has the potential to cause significant bronchospasm.
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Consultations

  • A pediatric pulmonologist may help diagnose and treat the underlying disorder and may also be helpful if bronchoscopy is necessary.
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Activity

  • As long as the child's oxygenation status is not compromised, activity should not be limited.
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Contributor Information and Disclosures
Author

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas Scanlin, MD  Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO  Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References

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  2. 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].

  3. [Guideline] National Heart, Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma (EPR-3). [Full Text].

  4. 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].

  5. De Boeck K, Willems T, Van Gysel D. Outcome after right middle lobe syndrome. Chest. Jul 1995;108(1):150-2. [Medline].

  6. 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.

  7. 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].

  8. 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].

  9. Schindler MB. Treatment of atelectasis: where is the evidence?. Crit Care. Aug 2005;9(4):341-2. [Medline].

  10. 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].

  11. Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. Dec 2000;118(6):1801-13. [Medline].

  12. 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].

  13. 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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Atelectasis. Left lower lobe collapse. The opacity is in the posterior inferior location.
 
 
 
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