Abstract
Lobar atelectasis is a common problem caused by a variety of mechanisms including resorption atelectasis due to airway obstruction, passive atelectasis from hypoventilation, compressive atelectsis from abdominal distension and adhesive atelectasis due to increased surface tension. However, evidence-based studies on the management of lobar atelectasis are lacking. Examination of air-bronchograms on a chest radiograph may be helpful to determine whether proximal or distal airway obstruction is involved. Chest physiotherapy, nebulised DNase and possibly fibreoptic bronchoscopy might be helpful in patients with mucous plugging of the airways. In passive and adhesive atelectasis, positive end-expiratory pressure might be a useful adjunct to treatment.
Highlights
In this issue of Critical Care, Hendriks and colleagues [1] report on the use of nebulised or endotracheal DNase in paediatric patients with atelectasis
These include: resorption atelectasis caused by resorption of alveolar air distal to obstructing lesions of the airways; adhesive atelectasis from increased surface tension and surfactant deficiency after ventilator-associated pneumonia; passive atelectasis caused by diaphragmatic dysfunction, or hypoventilation; compressive atelectasis due to spaceoccupying intrathoracic lesions or abdominal distension; and cicatrisation atelectasis due to pulmonary fibrosis [2]
Further examination of the chest radiograph to identify the level of air bronchogram may be helpful to identify whether airway obstruction is the cause and to determine whether proximal lobar or distal bronchi are involved [4]
Summary
In this issue of Critical Care, Hendriks and colleagues [1] report on the use of nebulised or endotracheal DNase in paediatric patients with atelectasis. Treatment modalities that have been described include chest physiotherapy [3], bronchodilators [3], fibreoptic bronchoscopy [4], DNase [1], positive end-expiratory pressure [5] and surfactant [6]. Chest physiotherapy is the traditional first-line therapy for atelectasis [4]; even for this basic therapy, evidence is lacking: there are only two published studies [7,8].
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