Pulmonary Atelectasis Follow-up

Updated: May 06, 2018
  • Author: Nazir A Lone, MD, MBBS, MPH, FACP, FCCP; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Follow-up

Further Outpatient Care

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  • Continued therapy is necessary to attempt to eliminate the atelectasis and to prevent further episodes.

  • If the child has asthma, prolonged taper of systemic steroids may help eliminate the airway swelling that predisposed the patient to atelectasis. Inhaled corticosteroids help control the asthma and prevent further episodes. Early recognitions of exacerbations of asthma and early therapy also prevent future problems.

  • If the child has cystic fibrosis, see Cystic Fibrosis for a more detailed discussion of the therapy of the disease.

  • If the child has neuromuscular disease or an abnormal chest wall, attempts to clear the airways, such as with chest physical therapy and postural drainage, help prevent atelectasis. The mechanical ex-insufflator is very helpful in mobilizing secretions in children with an ineffective cough. Some children benefit from positive pressure ventilation to maintain airway and alveolar patency. This should be performed in conjunction with a pediatric pulmonologist.

  • If aspiration due to gastroesophageal reflux or swallowing dysfunction predisposes to atelectasis, these causes should be addressed. Pharmacotherapy of gastroesophageal reflux is available. Speech therapists and occupational therapists can often assist with swallowing dysfunction.

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Further Inpatient Care

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  • The child with atelectasis should be kept in the hospital while in need of supplemental oxygen and therapy that cannot be adequately or appropriately administered at home.

  • Treatment may include antibiotics and chest physical therapy.

  • Children with neuromuscular disease may benefit from using a mechanical ex-insufflator, which is often part of their long-term home management.

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Inpatient & Outpatient Medications

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  • Therapy should be geared to the underlying disorder whenever possible.

  • If the child has asthma, then oral steroids, frequent inhaled bronchodilators, and high-dose inhaled steroids may help the underlying inflammation and bronchospasm. Antibiotics are not necessary.

  • If the child has cystic fibrosis, see Cystic Fibrosis for a discussion of appropriate therapy.

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Transfer

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  • Patients should be transferred to a tertiary care facility if they require a level of support that the referring institution is unequipped for or does not frequently perform in children.

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Deterrence/Prevention

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  • The appropriate long-term management of asthma should reduce the likelihood of the child developing atelectasis.

  • In children with cystic fibrosis, adequate use of the airway clearance mechanisms, sometimes in conjunction with antibiotics, can reduce the likelihood of atelectasis developing.

  • In children with neuromuscular disease, using a mechanical ex-insufflator (CoughAssist Device) can mobilize those secretions that predispose to atelectasis.

  • Routine use of chest physical therapy and postural drainage after extubation has not been shown to reduce the incidence of atelectasis.

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Complications

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  • Complications arising from the underlying disorder

  • Hypoxemia

  • Secondary infection of the atelectatic lung

  • Bronchiectasis in the atelectatic portion of a chronically infected lung

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Prognosis

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  • In most cases, the prognosis for the atelectasis is the same as the prognosis for the underlying disorder. If caused by a readily reversible disorder, the atelectasis should be reversible as well.

  • In children with significant neuromuscular disease and lower lobe atelectasis, the atelectasis may be very difficult to resolve.

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Patient Education

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