Which of the following problems occurs as a result of absorption atelectasis?

Atelectasis is a condition in which there is collapse of lung tissue (parenchyma) with loss of volume. The word "parenchyma" signifies the functional units, the alveoli, of the lungs. Atelectasis describes involvement of relatively smaller units (of alveoli). When larger units of lung parenchyma is involved it is called "collapse" (or collapsed lung), which is essentially just a larger atelectasis. Atelectasis does not involve the airways.

The loss of volume leads to an impaired gaseous exchange between CO2 and O2. It is a reversible condition and usually occurs secondary to an underlying pathology.[1][2]

• Atelectasis does not preferentially affect either sex.
• Incidence doesn't increase in patient with increased age, COPD or asthma.
• The incidence of atelectasis in patients who have recently undergone general anesthesia is as high as 90%
• It is commonly observed as a complication in post-operative patients whose breathing mechanism is impacted by the procedure, pain, and prolonged resting.
• Atelectasis is less commonly seen in patients with conditions like COPD, bronchiectasis, and cystic fibrosis.

• Cephalad displacement of the diaphragm in Obese and/or pregnant patients is more likely to cause atelectasis.[2]

It can be classified as follows[3]

1. pathophysiologic mechanism (e.g., compressive atelectasis)
2. the amount of lung involved (e.g., lobar, segmental, or subsegmental atelectasis)
3. the location (i.e., specific lobe or segment location).

Following table comprises the classification of atelectasis based on pathophysiologic mechanism[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]

• Passive Atelectasis
• Compressive Atelectasis

• Airway Stenosis
• Inflammation and edema caused by aspiration or inhalation injury (smoke, chemical agents)
• Edema of the airway
• Bronchial tumor
• Granuloma
• Papilloma
• Cardiomegaly
• Lobar Emphysema
• Vascular ring (innominate artery)
• Lymph node hypertrophy (tuberculosis)
• Tumors (mediastinum)
• Chylothorax
• Hemothorax
• Pneumothorax
• General anesthesia

• If there is a complete occlusion of the airway, the alveolar gas can only exit via the bloodstream and not the alveolar unit, this obstruction can cause atelectasis.
• The second and perhaps more important mechanism of gas resorption may occur due to the ventilation/perfusion mismatch in certain areas of the lung. If the alveolar oxygen increases because of the increased inspired oxygen concentration and the nitrogen does not, uptake will be high resulting in less alveolar splinting and decreased lung volume.

• Obstructive Atelectasis
• Cicatrizion Atelectasis

[20]

Atelectasis can be classified on the basis of location according to radiological patterns of collapse[12]

Complete Collapse[edit | edit source]

The white out (complete opacification of a hemithorax) can be seen in complete lung collapse. This appearance can be confused with a large pleural effusion, but the mediastinal shift towards a collapsed lung can distinguish it from pleural effusion where the shift is in the opposite direction of the pathology.

Lobar Collapse[edit | edit source]

Characteristic features associated with individual lobar collapse are as follows:

Right upper lobe (RUL) collapse[edit | edit source]

• Elevation of the right hilum
• Elevation of the minor fissure.
• Minor and major fissures may be visible on the lateral view.
• Golden S sign is present (The minor fissure is usually convex superiorly but may appear concave because of an underlying mass lesion).

Right middle lobe (RML) collapse[edit | edit source]

• Results in minimal opacity and is often overlooked.
• In a posterior -anterior view, the loss of silhouette of the right heart border can be seen.
• A wedge-shaped opacity can be seen on the lateral view as the result of right horizontal and oblique fissures moving towards each other.

Right lower lobe (RLL) collapse[edit | edit source]

• Triangular opacity can be seen alongside the right heart border.
• The right hemidiaphragm may appear elevated because of the obliteration.
• The right heart border is clearly seen.
• Loss of the right hemidiaphragm outline posteriorly and denser lower thoracic vertebrae can be observed on the lateral view.

Left upper lobe (LUL) collapse[edit | edit source]

• It appears as a veil-like opacity because of the absence of minor fissure, stretching out from the hilum and disappearing inferiorly.
• The major fissure is seen displaced anteriorly and the lower lobe is hyper-expanded on the lateral view.
• Luftsichel sign is present (hyper-expanded superior segment of the left lower lobe).

Left Lower Lobe (LLL) collapse[edit | edit source]

• Increased retrocardiac opacity is seen which shadows the left hemidiaphragm.
• Loss of the Left hemidiaphragm outline posteriorly and denser lower thoracic vertebrae can be observed on the lateral view.

The video below demonstrates the lobar classification of atelectasis on a radiograph:

[21]

Following are the clinical implications of atelectasis [15][22]

• Decreased lung compliance
• Hypoxemia
• Increased pulmonary vascular resistance (PVR)
• Inflammation as a local tissue biologic response
• Local immune dysfunction
• Damage of the alveolar-capillary barrier
• Potential loss of lung fluid clearance
• Increased lung protein permeability
• Susceptibility to infection
• Impaired penetration of antibiotics into lung tissue
• Factors that can initiate or exaggerate lung injury
• Acute respiratory failure.

The signs and symptoms of atelectasis are often non-specific:[1][23]

• Shallow breathing pattern

• Increased respiratory rate

• Increased work of breathing

• Reduced breath sound on the ipsilateral side of auscultation. In cases of the upper lobe atelectasis, bronchial sounds may be heard, because of the proximity to the major airways.

Following video explains the interpretation of the chest x-ray:

[29]

• It can be prevented by avoiding general anesthesia.[2]
• The use of continuous positive airway pressure (CPAP), low tidal volumes, lowest possible FiO2 during induction and maintenance, Positive end-expiratory pressure (PEEP), and lung recruitment maneuvers will help in preventing atelectasis at the point when the use of general anesthesia is unavoidable.[2]
• Early mobilization.[2][30][31][32]
• adequate pain control.[2]
• minimizing parenteral opioid administration.[2]

Management of atelectasis depends upon the duration and severity of the condition, from non-invasive intervention ( chest physiotherapy and pharmacological agents) to invasive treatment (bronchoscopy) can be opted according to the individual's state of health.[1]

Different physical therapy interventions have shown to be beneficial in the resolution of atelectasis. Physical therapy treatment can also be used as a preventative or prophylactic measure before surgery. [2]

The table below contains the different physical therapy treatment options in patients with atelectasis.[2][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]

• Kinetic Therapy: It is defined as the continuous turning of a patient slowly along the longitudinal axis to ≥ 40° onto each side, using a specialized bed.
• Turning side to side
• Prone positioning

• Sitting out of bed
• Standing on the first postoperative day,
• Walking a short distance in the room or corridor on the second postoperative day

The Video below demonstrates on the use incentive spirometer:

[51]

The Video below demonstrates on different chest physiotherapy treatment options in pediatric population:

[52]

Flexible bronchoscopy can be used for both diagnosing and treating a patient with atelectasis. It is a safe mode of treatment for lung collapse. It can be used under the following circumstances:

1. When the retained secretions with an air bronchogram pattern are present only to the extent of segmental bronchi causing lobar atelectasis.
2. when standard chest physiotherapy has been failed to produce a positive outcome.
3. Life-threatening partial- or complete-lung atelectasis
4. When vigorous chest therapy is not favorable for the patient or contraindicated for example individuals with chest trauma, unstable vertebral fractures, extensive burns, smoke inhalation, neuromuscular diseases, etc.
5. when there is a question in diagnosing the patient.[53]

Following video shows how bronchoscopy is performed to remove an inhaled foreign body:

[54]

Atelectasis is a pathology that often occurs secondary to an underlying condition or as a postoperative complication and can be significantly morbid or mortal. There is consensus in the literature whether or not it is always preventable but there are different conservative and non-conservative approaches that have shown to be effective in preventing and treating atelectasis.[2]

Which of the following occurs in atelectasis quizlet?

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