Chest
Volume 92, Issue 4, October 1987, Pages 621-624
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Clinical Investigations
Nasal Continuous Positive Airway Pressure in Atelectasis

https://doi.org/10.1378/chest.92.4.621Get rights and content

Nasal continuous positive airway pressure (CPAP) has been widely and safely used in the treatment of sleep disorders but has not been previously utilized for therapy of pulmonary atelectasis in adults. We observed three patients with significant atelectasis which was refractory to conventional chest physiotherapy. Bronchoscopy was not a viable therapeutic option in any patient. Therapy with continuous nasal CPAP was initiated at 10 to 15 cm H2O. The patients tolerated the therapy well and had prompt resolution of atelectasis. Nasal CPAP may be an effective modality for therapy of pulmonary atelectasis in spontaneously breathing patients, particularly when conventional therapies are not tolerated or are ineffectual.

Section snippets

CASE 1

A 23-year-old man with a history of neurofibromatosis was admitted because of respiratory distress. He had severe kyphoscoliosis and had undergone left shoulder disarticulation in the distant past. He was known to have severe pulmonary restriction as a result of his chest wall abnormalities and was chronically hypercarbic. Evaluation included a chest roentgenogram showing left bilobar atelectasis without air bronchograms. Room air arterial blood gas values were as follow: pH, 7.25; Pco2, 72; Po2

DISCUSSION

Pulmonary atelectasis is a commonly encountered problem following upper abdominal or thoracic surgery, in patients with neuromuscular disorders or obtundation, and in the critically ill. If not successfully treated, atelectasis can cause disturbances of gas exchange, increased work of breathing, and fever. Persistent atelectasis predisposes to pulmonary infection, and can lead to fibrosis with irreversible loss of functioning lung parenchyma.

Optimal therapy for atelectasis is controversial,7

ADDENDUM

Since submission of this report we have used nasal CPAP in another patient with refractory atelectasis.

A 70-year old man was admitted with the complaint of sudden onset of dyspnea and nonproductive cough. He had previously been in excellent health but had a long history of cigarette smoking. Examination showed him to be in mild distress with a respiratory rate of 22. Temperature at admission was 38.6°C. Initial chest x-ray film showed marked atelectasis of the right middle lobe. Arterial blood

REFERENCES (22)

  • R Mettey et al.

    Utilisation d’une canule nasale pour provoquer une pression expiratoire positive en neonatologie

    Arch Fr Pediatr

    (1984)
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    Manuscript received October 13; revision accepted February 13.

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