Wesleyan University-Philippines

College of Nursing and Allied Medical Sciences

Cushman Campus, Brgy. Mabini Extension, Cabanatuan
City, Nueva Ecija, 3100, Philippines
Tel no. +63 (044) 463-2162 / 463-2074 website:
admin@wesleyan.edu.ph

"ATELECTASIS"
OVERVIEW OF THE EXISTING HEALTH PROBLEM

Atelectasis is a complete or partial collapse of the entire lung

or area (lobe) of the lung. It occurs when the tiny air sacs
(alveoli) within the lung become deflated or possibly filled with
alveolar fluid.

Atelectasis is one of the most common breathing (respiratory)

complications after surgery. It's also a possible complication of
other respiratory problems, including cystic fibrosis, lung
tumors, chest injuries, fluid in the lung and respiratory
weakness. You may develop atelectasis if you breathe in a foreign
object.

Atelectasis can make breathing difficult, particularly if you

already have lung disease. Treatment depends on the cause and
severity of the collapse.
 ANATOMY AND PHYSIOLOGY

Atelectasis is a lung condition that happens when your airways or

the tiny sacs at the end of them don’t expand the way they should
when you breathe.

Your lungs are where your body takes in oxygen and gets rid of
carbon dioxide. When you breathe in, air flows into your
windpipe, or trachea. The trachea splits into two channels called
bronchi, and each bronchus goes to a lung.

Inside your lungs, those airways divide again and again into
smaller tubes called bronchioles. At the end of the smallest
bronchioles are tiny sacs called alveoli. Here, your blood dumps
carbon dioxide and picks up fresh oxygen to carry to the cells in
your body.

When you breathe in and out, your lungs inflate and deflate like
balloons. But if your airways get blocked or something puts
pressure on your lungs, they might not inflate the way they
should. Doctors call that condition atelectasis. It can be life-
threatening in small children or people who have another lung
problem.
Types of Atelectasis

The two main types of atelectasis are obstructive (also called

resorptive) and nonobstructive.

Obstructive atelectasis happens when something physically blocks

your airway.

Types of nonobstructive atelectasis include:

 Relaxation or compressive. The lining of your chest wall and

the surface of your lungs are usually in close contact,
keeping your lungs expanded. But if fluid or air builds up
and separates them, your lungs can pull inward, and your
alveoli can lose air. Depending on where this happens in
your lung, it's either relaxation or compressive
atelectasis.

 Adhesive. The fluid that lines the alveoli in your lungs has
a material in it called pulmonary surfactant. It helps your
lungs in several ways, including keeping the alveoli stable
and able to work. If there's a problem with this material
(like if your body doesn’t make enough of it), the alveoli
can collapse. When that happens, it's called adhesive
atelectasis. It can be caused by serious lung problems such
as respiratory distress syndrome or a bruised lung
(pulmonary contusion).

 Cicatricial. This type of atelectasis is when the tissue

that makes up your lungs has scars that keep them from being
able to hold as much air as they should. This scarring can
happen because of certain serious lung conditions like
sarcoidosis.

 Replacement. This is when your alveoli are filled by a

tumor. That causes an area of your lung to collapse.
  Acceleration. When jet pilots fly straight up really fast,
the acceleration can close the airways in their lungs,
leading to this type of atelectasis. It can make it hard to
breathe and cause chest pain and coughing.

 Rounded (also called folded lung). This type is linked to

pleural diseases, conditions that affect the thin tissue
that lines your chest cavity and surrounds your lungs (the
pleura). One of the most common causes is asbestosis, when
you breathe in asbestos over a long period of time and this
damages the pleura.

PATHOPHYSIOLOGY

REDUCED VENTILATION OR BLOCKAGE

OBSTRUCTION OF PASSAGE OF AIR FROM & TO ALVEOLI

TRAPPED ALVEOLAR AIR ABSORBED INTO BLOODSTREAM

AFFECTED PORTION OF ALVEOLI BECOMES

ALVEOLI COLLAPSE (ATELECTASIS)

Resorptive atelectasis

Something has blocked an airway and the distal lung collapses as

all gas in the blocked alveoli is sucked up into the capillaries.

Causes of this could include:

Intraluminal pathology: sputum plug, foreign body, aspiration

Mural pathology: carcinoma

Extramural pathology:peribronchial lymphadenopathy, an enlarged

left atrium, etc.

Passive atelectasis

Something has interrupted the negative pressure between the

visceral and parietal pleura. The lung collapses passively as a
result.

Causes of this include pleural effusion and pneumothorax.

Compressive atelectasis

Something has put direct pressure on the lung, collapsing the

alveoli.

Causes of this include masses (cancer and abscess) or enlarged

mediastinal structures (thoracic aneurysms or cardiomegaly

Cicatrisation atelectasis

Something has caused parenchymal scarring, and the extent of the

scar tissue limits the expansion of surrounding parenchyma.

Causes of this include pulmonary fibrosis, recovery from

necrotising pneumonia, and radiation pneumonitis

Adhesive atelectasis

Something has caused surfactant to fail. Usually, because it is

not being produced (eg. the hyaline membrane disease of the
newborn). The alveoli collapse in the absence of surfactant.

Dependent atelectasis

Gravity is responsible for the collapse of lung bases in a

chronically supine or recumbent person, in the absence of regular
vigorous deep breathing exercises. The weight of the lung above
pushes on the lung below, producing compression. Under real-world
condition, the weight of the massive obese chest wall and
distended post-operative abdomen are also contributing to this.

Signs and Symptoms

If you have atelectasis, you'll feel like you can’t get enough air.
Other symptoms can include:

 Coughing

 Chest pain

 A fast heart rate

 Bluish skin or lips

 Difficulty breathing

 Rapid, shallow breathing

 Wheezing

MEDICAL AND SURGICAL TREATMENT

Treating atelectasis depends on the underlying cause and how
severe your symptoms are.

If you’re having trouble breathing or feel like you’re not

getting enough air, seek immediate medical treatment.

You may need the assistance of a breathing machine until your

lungs can recover and the cause is treated.

Nonsurgical treatment

Most cases of atelectasis don’t require surgery. Depending on the

underlying cause, your doctor might suggest one or a combination
of these treatments:
  Chest physiotherapy. This involves moving your body into
different positions and using tapping motions, vibrations,
or wearing a vibrating vest to help loosen and drain mucus.
It’s generally used for obstructive or postsurgical
atelectasis. This treatment is commonly used in people with
cystic fibrosis as well.
 Bronchoscopy. Your doctor can insert a small tube through
your nose or mouth into your lungs to remove a foreign
object or clear a mucus plug. This can also be used to
remove a tissue sample from a mass so that your doctor can
figure out what is causing the problem.
 Breathing exercises. Exercises or devices, such as an
incentive spirometer, that force you to breathe in deeply
and help to open up your alveoli. This is especially useful
for postsurgical atelectasis.
 Drainage. If your atelectasis is due to pneumothorax or
pleural effusion, your doctor may need to drain air or fluid
from your chest. To remove fluid, they’ll likely insert a
needle through your back, between your ribs, and into the
pocket of fluid. To remove air, they may need to insert a
plastic tube, called a chest tube, to remove extra air or
fluid. The chest tube may need to be left in for several
days in more severe cases.

Surgical treatment

In very rare cases, you may need to have a small area or lobe of
your lung removed. This is usually only done after trying all
other options or in cases involving permanently scarred lungs.

Laboratory Study
Atelectasis Diagnosis
A doctor's examination and plain chest X-ray may be all that is needed
to diagnose atelectasis. However, other tests may be done to confirm
the diagnosis or determine the type or severity of atelectasis. They
include:

CT scan. Since a CT is a more sensitive technique than an X-ray, it

may sometimes help better detect the cause and type of atelectasis.

Oximetry. This simple test uses a small device placed on one of your
fingers to measure your blood-oxygen level. It helps determine the
severity of atelectasis.

Ultrasound of the thorax. This noninvasive test can help tell the
difference between atelectasis, hardening and swelling of a lung due
to fluid in the air sacs (lung consolidation), and pleural effusion.

Bronchoscopy. A flexible, lighted tube inserted down your throat

allows your doctor to see what may be causing a blockage, such as a
mucus plug, tumor or foreign body. This procedure may also be used to
remove the blockages.

Discharge Planning
Medicines:
Depending on the cause, you may receive any of the following:

 Bronchodilators help dilate your airway to make breathing

easier.

 Mucolytics help thin mucus so it is easier to cough out.

 Antibiotics help treat or prevent an infection caused by

bacteria.

 Pain medicine may be given. Pain control will allow you to

cough and breathe deeply. Do not wait until the pain is
severe before you ask for more medicine.
Health Teaching
 Postural drainage means getting into positions that help
mucus drain. Postural drainage is sometimes used with chest
percussion (gentle clapping to help move the mucus out of
your lungs). Ask your healthcare provider for more
information about postural drainage and chest percussion.

 Frequent coughing can help clear mucus from your lungs.

 Deep breathing exercises help improve your lung function and

reduce your risk for atelectasis. An incentive spirometer
may be used after surgery to help you breathe deeply and
slowly. Ask your healthcare provider for more information on
deep breathing exercises.

 Change your position to promote lung expansion and reduce

the risk for infection. Sit on the side of the bed or walk
frequently after surgery as directed.
 Drink liquids as directed to help loosen mucus. Ask how much
liquid to drink each day and which liquids are best for you.

If your atelectasis is due to bed rest, sedation, shallow

breathing, or obesity, do the following to help increase air flow
in your lungs.

 If you were given an incentive spirometer device, use it as

directed.

 If you were not given an incentive spirometer, take 4 very

deep breaths every 1 to 2 hours while awake. As you exhale,
purse your lips as if you were blowing up a balloon. (If
possible, actually blow up a balloon or a rubber glove.

Yoga and Exercise

Improve your pulmonary function and reduce the risk of a
collapsed lung with deep-breathing exercises.

Practice pursed-lip breathing to help conquer a shortness-of-

breath feeling that is common to people with lung disease and to
improve lung function.

DIET AND NUTRITION

Food and Nutrition

Foods to be taken

 Drinking at least 8 glasses of water or other fluids daily

may help to thin lung secretions making them easier to cough
up
 Garlic has anti-inflammatory as well as antibiotic
properties which can be made use of in healing the lungs
 Consume 3 to 4 dried figs every day in the mornings as dried
figs are good to strengthen the immune system

Foods to be avoided

 Refined and processed foods

 Fatty and junk foods

REFERENCES:

https://www.mayoclinic.org/diseases-
conditions/atelectasis/symptoms-causes/syc-20369684

https://my.clevelandclinic.org/health/diseases/17699-atelectasis

https://www.mtatva.com/en/disease/atelactasis-treatment-diet-and-
home-remedies/

https://emedicine.medscape.com/article/296468-overview