Lung Expansion Therapy & Atelectasis

• Lung expansion techniques aim to improve pulmonary function via alveolar recruitment and optimized airway clearance.
• Post-operative pulmonary complications are common after upper abdomen or thorax surgeries.
• These complications include atelectasis, pneumonia, and acute respiratory failure.
• Lung expansion therapy helps prevent or correct postoperative respiratory complications.

Causes & Types of Atelectasis

• Gas absorption atelectasis occurs when mucus plugs block ventilation or due to V/Q mismatch, causing gas distal to the obstruction to be absorbed by blood.
• Compression atelectasis results from persistent breathing with small tidal volumes or certain restrictive chest-wall disorders.

Factors Causing Atelectasis

• Obesity
• Neuromuscular disorders
• Heavy sedation
• Surgery near the diaphragm
• Bed rest
• Poor cough
• History of lung disease
• Restrictive chest-wall abnormalities

Clinical Signs of Atelectasis

• Recent major surgery
• Tachypnea
• Fine, late-inspiratory crackles
• Bronchial or diminished breath sounds
• Tachycardia
• Increased density and volume loss signs on chest radiograph

Incentive Spirometry (IS)

• Incentive spirometry involves slow, deep breaths (inhalation) through a handheld device.
• Incentive spirometry has been a lung expansion therapy mainstay for many years
• IS devices give patients visual cues to reach desired inspiratory volume or flow.
• IS is effective in high-risk patients.
• Incentive spirometry equipment is simple, portable, and inexpensive.
• Incentive spirometry devices are either flow or volume oriented.
• Flow-oriented devices are more popular because they are smaller.
• The need for IS is determined by patient assessment.
• Effective patient teaching is essential.
• Demonstrate and observe the patient.
• Patients should sustain maximal inspiratory effort for 5 to 10 seconds.
• Follow-up is important.

Intermittent Positive Pressure Breathing (IPPB)

• Intermittent Positive Pressure Breathing uses positive airway pressure to expand the lungs.
• Treatments last 15 to 20 minutes.
• Exhalation is passive.
• IPPB is indicated for patients with atelectasis not responsive to IS or those at high risk who cannot perform IS.

Positive Airway Pressure (PAP) Therapy

• Positive Airway Pressure includes PEP, EPAP, and CPAP.
• Positive Airway Pressure treats atelectasis and cardiogenic pulmonary edema.
• Positive Airway Pressure is contraindicated in hemodynamically unstable patients or those with hypoventilation.
• Hazards and complications include barotrauma, hypoventilation, gastric distention, vomiting, and aspiration.
• System leaks are the most common problem.
• Monitor patients for hypoventilation and elevated PCO2.
• Ensure inspiratory flow is adequate.

Selecting an Approach

• Choose the safest, simplest, and most effective modality.
• Evaluate patient cooperation, amount of pulmonary secretions, and spontaneous vital capacity before choosing a modality.

Lung expansion techniques enhance pulmonary function through alveolar recruitment and airway clearance. Post-operative pulmonary complications, including atelectasis and pneumonia, can be prevented or corrected through lung expansion therapy. Learn about the causes, types, and risk factors associated with atelectasis.