Pulmonary Atelectasis Treatment & Management
- Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD more...
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- Antibiotics are not necessary in the child with asthma. Oral corticosteroids, together with frequent inhaled bronchodilators and continued high-dose inhaled corticosteroids, would address any 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.
- 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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- 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. In mechanically ventilated children who had undergone cardiac surgery, nebulized DNAse was able to ameliorate atelectasis after 10 doses. It was more effective in children with high neutrophil counts in the affected area. Bronchoscopic installation of surfactant was successful in opening the areas of atelectasis and helping wean children from mechanical ventilation. 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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- A pediatric pulmonologist may help diagnose and treat the underlying disorder and may also be helpful if bronchoscopy is necessary.
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- As long as the child's oxygenation status is not compromised, activity should not be limited.
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