Management of Atelectasis

Primary Management Strategies

The American College of Physicians recommends alveolar recruitment maneuvers involving transient elevation of airway pressures (30-40 cm H2O for 25-30 seconds) to effectively re-expand collapsed lung tissue in patients with atelectasis, with a strength of evidence rated as high 1
The American Thoracic Society suggests that positive end-expiratory pressure (PEEP) strategies are recommended for patients with moderate or severe respiratory distress to reduce atelectasis, with a strength of evidence rated as moderate 1
The European Respiratory Society recommends that PEEP should be adjusted based on patient response to avoid alveolar overdistention or collapse, with a strength of evidence rated as high 1

The European Respiratory Society recommends flexible bronchoscopy for direct visualization and removal of obstructing secretions in cases of persistent mucous plugs causing atelectasis, with a strength of evidence rated as high 2
The American College of Chest Physicians suggests that mucus plugs or blood clots in the airways causing atelectasis can be removed with the flexible bronchoscope, with a strength of evidence rated as moderate 3

The American Association for Respiratory Care recommends optimizing patient positioning with head elevated at least 30 degrees to improve lung expansion, with a strength of evidence rated as high 1, 2
The European Respiratory Society suggests that early mobilization and physical activity should be encouraged as immobility contributes to deterioration in lung function, with a strength of evidence rated as moderate 2

The American Society of Anesthesiologists recommends that high FiO2 (>0.8) during emergence from anesthesia should be avoided as it significantly increases atelectasis formation, with a strength of evidence rated as high 1
The European Society of Anaesthesiology suggests that if clinically appropriate, use FiO2 <0.4 during emergence to reduce atelectasis, with a strength of evidence rated as moderate 1

The American College of Surgeons recommends considering CPAP immediately post-extubation, especially in obese patients, to reduce atelectasis, with a strength of evidence rated as high 1
The European Society of Anaesthesiology suggests that postoperative CPAP (7.5-10 cm H2O) may reduce atelectasis, pneumonia, and reintubation rates after major abdominal surgery, with a strength of evidence rated as moderate 1

The European Respiratory Society recommends that in children, flexible bronchoscopy should be performed for persistent atelectasis, unexplained episodes of cyanosis, and unexplained respiratory distress, with a strength of evidence rated as high 3
The American Academy of Pediatrics suggests that suctioning may be necessary when cough is inadequate to clear secretions, but routine deep suctioning should be avoided, with a strength of evidence rated as moderate 2

The European Respiratory Society recommends that in neonates with persistent atelectasis, bronchoscopy can provide valuable diagnostic information and therapeutic intervention, with a strength of evidence rated as high 3
The American Academy of Pediatrics suggests that newer flexible bronchoscopes with improved suction channels allow therapeutic maneuvers including aspiration of mucous plugs in neonates, with a strength of evidence rated as moderate 3