Atelectasis in children
- Jonathan D Finder, MD
Jonathan D Finder, MD
- Professor of Pediatrics
- University of Pittsburgh School of Medicine
The word atelectasis is of Greek origin and means lack of stretch; in medical usage, the term refers to collapse or loss of lung volume. Atelectasis is also defined as collapse of alveolar spaces, generally of a magnitude severe enough to appear on a plain chest radiograph. Atelectasis is a common problem in pediatric patients. The three main types of atelectasis noted in children include obstructive atelectasis, resorptive atelectasis, and compressive atelectasis. In almost all cases, atelectasis is acquired and referred to as secondary; rarely, primary atelectasis caused by congenital abnormalities may be present from birth. An overview of atelectasis in children is presented here. The radiographic appearance of atelectasis and an overview of atelectasis in adults are discussed separately. (See "Radiologic patterns of lobar atelectasis" and "Atelectasis: Types and pathogenesis in adults".)
In order to understand the pathophysiology of atelectasis, a review of the normal mechanisms that prevent lung collapse is required. Elastin fibers within alveolar walls result in a tendency for the alveoli to recoil inwards. This is balanced by the outward recoil of the chest wall and the interaction between the parietal and visceral pleura. In addition, the primary mechanism that keeps the lung from collapsing at low volumes is surfactant.
Surfactant is a complex phospholipid and protein mixture produced by type II alveolar epithelial cells. It functions to lower surface tension, which is defined by the law of Laplace:
Pressure = 2 x (surface tension) / radius
As alveolar volume decreases with expiration, surface tension increases to the degree that, without surfactant, the alveolus would collapse completely. This adhesive atelectasis becomes clinically relevant in diseases that result in absent or deficient surfactant production and homeostasis, including neonatal respiratory distress syndrome, congenital surfactant protein B deficiency, and pulmonary alveolar proteinosis. (See "Overview of neonatal respiratory distress: Disorders of transition" and "Causes, clinical manifestations, and diagnosis of pulmonary alveolar proteinosis in adults".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Zopf DA, Hollister SJ, Nelson ME, et al. Bioresorbable airway splint created with a three-dimensional printer. N Engl J Med 2013; 368:2043.
- Wallis C, McLaren CA. Tracheobronchial stenting for airway malacia. Paediatr Respir Rev 2017.
- Kaditis AG, Motoyama EK, Zin W, et al. The effect of lung expansion and positive end-expiratory pressure on respiratory mechanics in anesthetized children. Anesth Analg 2008; 106:775.
- Muller NL, Fraser RS, Colman NC, et al. Radiologic diagnosis of diseases of the chest, Saunders, Philadelphia, 2001.
- Stark P, Leung A. Effects of lobar atelectasis on the distribution of pleural effusion and pneumothorax. J Thorac Imaging 1996; 11:145.
- Schindler MB. Treatment of atelectasis: where is the evidence? Crit Care 2005; 9:341.
- Galvis AG, Reyes G, Nelson WB. Bedside management of lung collapse in children on mechanical ventilation: saline lavage--simulated cough technique proves simple, effective. Pediatr Pulmonol 1994; 17:326.
- Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest 2000; 118:1801.
- Miske LJ, Hickey EM, Kolb SM, et al. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest 2004; 125:1406.
- Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest 1993; 104:1553.
- Finder JD, Birnkrant D, Carl J, et al. Respiratory care of the patient with Duchenne muscular dystrophy: ATS consensus statement. Am J Respir Crit Care Med 2004; 170:456.
- Birnkrant DJ, Bushby KM, Amin RS, et al. The respiratory management of patients with duchenne muscular dystrophy: a DMD care considerations working group specialty article. Pediatr Pulmonol 2010; 45:739.
- Fauroux B, Guillemot N, Aubertin G, et al. Physiologic benefits of mechanical insufflation-exsufflation in children with neuromuscular diseases. Chest 2008; 133:161.
- Siriwat R, Deerojanawong J, Sritippayawan S, et al. Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children With Cerebral Palsy. Respir Care 2017.
- Birnkrant DJ, Pope JF, Lewarski J, et al. Persistent pulmonary consolidation treated with intrapulmonary percussive ventilation: a preliminary report. Pediatr Pulmonol 1996; 21:246.
- Deakins K, Chatburn RL. A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy for the treatment of atelectasis in the pediatric patient. Respir Care 2002; 47:1162.
- Reardon CC, Christiansen D, Barnett ED, Cabral HJ. Intrapulmonary percussive ventilation vs incentive spirometry for children with neuromuscular disease. Arch Pediatr Adolesc Med 2005; 159:526.
- Toussaint M, De Win H, Steens M, Soudon P. Effect of intrapulmonary percussive ventilation on mucus clearance in duchenne muscular dystrophy patients: a preliminary report. Respir Care 2003; 48:940.
- Sorenson HM, Shelledy DC, AARC. AARC clinical practice guideline. Intermittent positive pressure breathing--2003 revision & update. Respir Care 2003; 48:540.
- Strickland SL, Rubin BK, Haas CF, et al. AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients. Respir Care 2015; 60:1071.
- Abu-Hasan MN, Chesrown SE, Jantz MA. Successful use of bronchoscopic lung insufflation to treat left lung atelectasis. Pediatr Pulmonol 2013; 48:306.
- Wu KH, Lin CF, Huang CJ, Chen CC. Rigid ventilation bronchoscopy under general anesthesia for treatment of pediatric pulmonary atelectasis caused by pneumonia: A review of 33 cases. Int Surg 2006; 91:291.
- Deng J, Zheng Y, Li C, et al. Plastic bronchitis in three children associated with 2009 influenza A(H1N1) virus infection. Chest 2010; 138:1486.
- Terano C, Miura M, Fukuzawa R, et al. Three children with plastic bronchitis associated with 2009 H1N1 influenza virus infection. Pediatr Infect Dis J 2011; 30:80.
- Obstructive atelectasis
- Resorptive atelectasis
- Relaxation atelectasis
- Compressive atelectasis
- PHYSICAL FINDINGS
- RADIOLOGIC ASSESSMENT
- Plain films
- CT scan
- LABORATORY ABNORMALITIES
- Chest physiotherapy
- Mechanical insufflation-exsufflation
- Intrapulmonary percussive ventilation
- Intermittent positive pressure breathing
- Mucolytic therapies
- - DNase
- - N-acetylcysteine
- Invasive approaches
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS