Atelectasis Management in CVICU

Definition and Signs

Atelectasis in the CVICU is a state of collapsed and non-aerated lung regions that requires prompt identification and management to prevent severe complications including hypoxemia and respiratory failure, according to Praxis Medical Insights 1

Monitor for signs of atelectasis through observation of bilateral chest wall expansion during ventilation, as recommended by Praxis Medical Insights 1
Utilize lung ultrasound or chest X-ray to confirm diagnosis and extent of atelectasis, especially when there is doubt about bilateral lung ventilation, according to Praxis Medical Insights 1

Decreased oxygen saturation and hypoxemia (may be severe) are common clinical manifestations of atelectasis, as reported in Anaesthesia 2
Diminished or absent breath sounds over affected areas are a sign of atelectasis, according to Praxis Medical Insights 1
Asymmetric chest wall movement during ventilation is a clinical manifestation of atelectasis, as noted by Praxis Medical Insights 1

Apply positive end-expiratory pressure (PEEP) of 6-15 cmH2O, with higher PEEP for moderate to severe cases, as recommended by Praxis Medical Insights 1
Ensure endotracheal tube cuff pressure is maintained at 20-30 cmH2O to prevent leaks while avoiding excessive pressure on the tracheal mucosa, according to Praxis Medical Insights 1
Use closed tracheal suction systems to minimize aerosol generation and maintain lung volume, as suggested by Praxis Medical Insights 1

Consider high-flow oxygen therapy via nasal cannula after extubation for hypoxemic patients, as recommended by Praxis Medical Insights 1
Use non-invasive ventilation (NIV) after extubation for patients at high risk of reintubation, especially those with hypercapnia, according to Praxis Medical Insights 1
Provide physiotherapy before and after extubation for patients ventilated for more than 48 hours, as suggested by Praxis Medical Insights 1

Check endotracheal tube cuff pressure and depth before and after any patient repositioning to prevent tube displacement, as recommended by Praxis Medical Insights 1
Consider using an endotracheal tube with a subglottic suction port to help manage secretions, according to Praxis Medical Insights 1
During procedures requiring circuit disconnection, ensure adequate sedation, consider neuromuscular blockade, pause the ventilator, clamp the endotracheal tube, and separate the circuit with the heat and moisture exchanger filter attached to the patient, as suggested by Praxis Medical Insights 1
Be vigilant for heat and moisture exchange filter blockage, which can cause increased airway resistance that may be mistaken for patient deterioration, as noted by Praxis Medical Insights 1
Monitor for tube displacement during sedation holds, according to Praxis Medical Insights 1

Properly position endotracheal tubes and record tube depth at every shift, as recommended by Praxis Medical Insights 1
Consider having a physiotherapist attend endotracheal extubation to limit immediate complications, according to Praxis Medical Insights 1