Chest
Clinical InvestigationsNasal Continuous Positive Airway Pressure in Atelectasis
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
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Cited by (43)
Acute Lobar Atelectasis
2019, ChestContinuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac Surgical Ward: A Randomized Trial
2017, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The sample size was relatively small, and it was not blinded, although the primary endpoint, based on arterial blood samples, was objective, thus decreasing the risk of bias. The authors acknowledge that the best methods to deliver a fixed FIO2 exist (eg, high-flow blenders)10 and were not used in this pragmatic study. They also acknowledge that they did not exclude patients who had prolonged mechanical ventilation, and they did not collect data on antibiotic treatment.
Role of non-invasive ventilation (NIV) in the perioperative period
2010, Best Practice and Research: Clinical AnaesthesiologyCitation Excerpt :These early and transitory modifications of respiratory function may lead to respiratory failure affecting the ‘pump’ function (respiratory muscles) as well as the ‘exchange’ function (lungs).12–14 Initially, the clinical experience reported in postsurgical patients is limited to the use of positive end-expiratory pressure (PEEP) alone without positive inspiratory pressure support ventilation (PSV) called CPAP.15–18 Moreover, in these studies,15–18 CPAP was used to prevent ARF after surgery (prophylactic use, i.e., immediately following extubation, not waiting for patients to develop respiratory distress) but not to treat ARF once it developed (curative use).19
Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: A prospective, randomized, controlled trial in 500 patients
2009, ChestCitation Excerpt :To calculate the Pao2/Fio2 ratio, the oxygen concentration at the oxygen blender was chosen as Fio2. For oxygen flows of at least 25 L/min, the chosen concentration is similar to the actual inspiratory oxygen concentration.7 Severe pulmonary oxygenation dysfunction was defined as a Pao2/Fio2 ratio of < 100.
Neonatal physiotherapy using the insufflation technique for removing atelectasia
2007, Kinesitherapie
Manuscript received October 13; revision accepted February 13.