Surgical Critical Care: Atelectasis

Basics

• Definition: Alveolar Collapse Causing Loss of Lung Volume
• Commonly Seen in Smokers, Postoperative Patients or After Chest Trauma

Classification/Causes

• Obstructive/Resorptive – Retained Gas Behind Occluded Airway is Resorbed Causing Collapse
  • Develops Faster in Patients with High FiO2
  • Causes: Mucous Plugging, Foreign Body, Tumor Occlusion
• Relaxation/Passive – Loss of Contact Between Parietal & Visceral Pleura
  • From a Pleural Effusion or Pneumothorax
• Compressive – Space Occupying Lesions Cause Compression & Collapse
• Adhesive – Collapse Due to Alveolar Instability
  • May be Related to Surfactant Deficiency
• Cicatricial – Collapse from Severe Parenchymal Scarring
• Replacement – Volume Loss from Tumor Replacement of Alveoli

Presentation

• Most are Asymptomatic
• Cough
• Dyspnea
• Pleuritic Chest Pain
• Complications:
  • Pneumonia
  • Respiratory Failure

Diagnosis

• CXR (Lung Opacification or Loss of Lung Volume)
• May Also Be Seen Other Imaging (CT, etc.)

Treatment

• Primary Treatment: Incentive Spirometry, Cough & Deep Breathing Exercise
• May Require Bronchoscopy/Suctioning for Obstructive Causes Such as Foreign Body or Mucous Plugging