Pulmonary Atelectasis

Abstract

Atelectasis occurs in the dependent parts of the lungs of most patients who are anesthetized. Development of atelectasis is associated with decreased lung compliance, impairment of oxygenation, increased pulmonary vascular resistance, and development of lung injury. The adverse effects of atelectasis persist into the postoperative period and can impact patient recovery. This review article focuses on the causes, nature, and diagnosis of atelectasis. The authors discuss the effects and implications of atelectasis in the perioperative period and illustrate how preventive measures may impact outcome. In addition, they examine the impact of atelectasis and its prevention in acute lung injury.

Feasibility of standard mechanical ventilation with low FiO2 and small endotracheal tubes during laser microlaryngeal surgery

“…15 Anesthesia and muscle paralysis have been demonstrated to favor atelectasis formation by reducing functional residual capacity, particularly in markedly obese patients with high intra-abdominal pressure. 15,16,23 It is possible that the high-resistance ETT ensues an increase in auto-PEEP preventing the development of atelectasis. 24 We excluded patients with radiological chest abnormalities.…”

Perioperative lung protective ventilation

“…Atelectasis develops through the compression of lung parenchyma, resorption of alveolar gas, and impaired surfactant function 24. Induction of general anesthesia and chemical paralysis alters the geometry and function of the diaphragm and chest wall, leading to increased pleural pressure and collapse of dependent lung regions 2526.…”

“…In addition, the sigh reflex used to mitigate atelectasis in the awake state is abolished under anesthesia 30. Atelectasis has many adverse physiologic consequences including intrapulmonary shunting, decreased compliance, increased pulmonary vascular resistance, and susceptibility to inflammatory lung injury 9243132. This susceptibility is potentially not limited solely to atelectatic lung segments, as preclinical data have shown that concurrent inflammation can occur remotely in regions with intact ventilation 33.…”

Atelectasias em pediatria: mecanismos, diagnóstico e tratamento

“…Para reexpandir áreas com atelectasia é necessário que os plugs de muco sejam removidos e que ocorra aumento da pressão transpulmonar 36,37,38 . A técnica de compressão e descompressão torácica brusca auxilia na remoção do muco, pois aumenta o tempo expiratório, mas não contribui para a reexpansão pulmonar em pediatria, pois para que isto ocorra é necessária a utilização de altas pressões inspiratórias 36 .…”