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Atelectasis means imperfect expansion, it refers to the incomplete expansion of a lung


or portion of a lung. This order may be present at birth (primary atelectasis), ot it may develop
in the neonatal period or in later life (acquired or secondary atelectasis). The term atelectasis is
derived from the Greek words ateles and ektasis, meaning incomplete expansion.

The disorders of the pleura include pain, pneumothorax, and pleural effusion. Pain is
commonly associated with condition that produce inflammation of the pleura.
Characteristically, it is unilateral, abrupt in onset, and exaggerated by respirstory movements.
Pneumothorax refers to an accumulation of air in the pleural cavity with the partial or complete
collapseof the lung. It can result from rupture of an air-filled bleb on the lung surface or from
the penetrating or non-penetrating injuries. A tension pneumothorax is a life threatening event
in which air progressively accumulates within the thorax. Causing not only the collapse of the
lung on the injured side but also a progressive shift of the mediastinum to the opposite side of
the thorax, producing severe cardiorespiratory impairment. Pleural effusion refers to the
collection of fluid in the pleural cavity. The fluid may be transudate (hydrothorax), exudates
(empyema), blood (hemothorax), or chyle (chylothorax).

Primary atelectasis of the newborn implies that the lung has never been inflated. It is
seen most frequently in premature and high-risk infants. A secondary form of atelectasis can
occur in infants who established respiration and subsequently developed impairment of the
lung expansion. Among the causes of secondary atelectasis in the newborn are the respiratory
distress syndrome associated with lack of surfactant and airway obstruction due to aspiration
of amniotic fluid or blood. It result in a patchy form of atalectasis. Acquired atelectasis occurs
mainly in adult. It is most commonly caused by airway obstruction and lung compression.
Obstruction caused by a mucous plug within the airway or by external compression due to fluid,
tumor mass, exudates, or other matter in the area surrounding the airway. A small segment of
lung or an entire lung lobe may be involved in obstructive atelectasis. Complete obstruction of
an airway is followed by the absorption of air from the dependent alveoli and collapse of that
portion of the lungs. Breathing high concentrations of oxygen, such as while on a ventilator,
increases the rate at which gases are absorbed from the alveoli and predisposes to atelectasis.

Both chest compression and breath sound are decreased on the affected side. There
may be intercostal retraction over the involved area during inspiration. If the collapsed area is
large, the mediastrium and trachea shift to the affected side. Sign of respiratory distress
proportional to the extent of lung collapse. The danger of obstructive atelactasis increases after
surgery. Anesthesia, pain, administration of narcotics, and immobility tend to promote
retention of viscid bronchial secretions and hence airway obstruction.
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ACUTE OBSTRUCTION

ALVEOLI ABSORBS ALVEOLAR GAS

HYPOXEMIA

EXTENSIVE ALVEOLAR HYPOVENTILATION

HYPOXIA

PNEUMONIA

PULMONARY EDEMA

LUNG COLLAPSE

Following acute obstruction to bronchus, the capillary surrounding the alveoli absorbs
the alveolar gas, causing airlessness, lung retraction and collapse. Despite blood perfusion,
hypoxemia occurs, because there is no air in the lung to transfer the oxygen. Extensive alveolar
hypoventilation may result in an effective right to left shunt of blood in the heart which also
leads to hypoxia. The impaired breathing resulting from alveolar collapse also leads to hypoxia
and pneumonia. Tissue hypoxia results in entry (transudation) of fluid in to the alveoli leading
to pulmonary edema, which may prevent complete collapse of the atelectatic lung.

The reduced alveolar distention results in decreased surfactant production which


propagates the atelectasis further. Mobilization of secretions may be inhibited by inflammatory
lung disease leading to edema, with a need for tracheal intubation.
In non-obstructive case, changes in alveolar surface tension, lung-pleura pressure and
alveolar size, cause inadequate regional ventilation and atelectasis. There is loss of negative
pressure in the pleural space in case of pleural effusion or pneumothorax. In such cases the
lung tends to recoil due to elastic property and becomes atelectatic.



It can be caused by airway obstruction, increased recoil of the lung due to loss of
pulmonary surfactant or the lung compression such as occurs in pneumothorax or
pleural effusion. It occurs when the pleural cavity is partially or completely filled with
fluid, exudates, blood, a tumor mass or air.



j Pneumonia
j Scarring of lung tissue: pulmonary fibrosis

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The clinical manifestation of atelectasis includes tachypnea, tachycardia,


dyspnea, cyanosis, sign of hypoxemia, diminished chest expansion, absence of breath
sounds, and intercostal retractions. Fever and other sign of infection that may develop.

 

The incidence and prevalence of atelectasis is not well known. However


postoperative atelectasis and lobar atelectasis are the common types. There is no
specific racial or sex predilection.

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Diagnosis is based on clinical and x-ray findings.

There is diminution of lung size (rib retraction and crowding, elevated diaphragm,
deviated trachea and mediastinum, and compensatory increased distention of unaffected lung),
airless dense opacification of the affected lobe (as seen in x-ray). Compensatory hyperinflation
as evidenced by increased radiolucency can be seen in the normal lobe or unaffected lung.

Posterior-anterior and lateral chest x-rays are usually requested for. Radiographic
appearance may vary from complete collapse to relatively normal-appearing lungs. In practice
the involvement is more extensive than is suggested by the x-ray.

Bronchoscopy and CT scan of thorax may be more valuable in identifying the affected
site and cause.


!

Adequate management of chronic bronchitis through antibiotics,


bronchodilators to improve ventilation, bronchial toiletry to liquify thick sputum, suction
to remove secretions, prohibition of smoking, judicious use of central nervous system
depressant drugs, intermittent positive pressure breathing (IPPB), deep breathing
exercises, respiratory physiotherapy, encouragement of cough and early movement
would prevent development of atelectasis, in appropriate situations.

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The treatment depends on the cause and extent of lung involvement. It is directed at
reducing the airway obstruction or lung compression and at reinflating the collapsed area of the
lung. Ambulation and body positions that favor increased lung expansion are used when
appropriate. Administration of oxygen may be needed to treat the hypoxemia. Bronchoscopy
may be used as both a diagnostic and treatment method.

%

Apart from antibiotics, specific antituberculous, antifungal drugs may be needed


depending upon the etiology.

Bronchodilators (beta adrenergic agonists like salbutamol, anticholinergics like


ipratropium) may be necessary improve ventilation. Mucolytics like acetyl cysteine to
liquify sputum may be more useful especially if directly applied via a bronchoscope.

%

Prognosis depends upon the cause, age of the patient, underlying complications
and the management. It is usually good in case of post-operative atelectasis and poor in
case of advanced cancer.

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j Pathopysiology ͞concepts of altered health status͟, Carol Mattson Porth, 4th


edition, J.B. Lippincott Company, Philadelphia USA, c 1994.
Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City

COLLEGE OF HEALTH SCIENCES

In partial

Fulfilment of the

Requirements in the course:

Pathophysiology

ATELECTASIS

Presented to:

Mark Velasco, RN

Instructor

Presented by:

Mark Kevin Reboldela

III-A-Paramedics
October 11, 2010