Atelectasis: mechanisms, diagnosis and management

Peroni, Diego; Boner, Attilio

doi:10.1053/prrv.2000.0059

Cited by 100 publications

(133 citation statements)

References 10 publications

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“…Atelectasis in our patients may have been caused by mucus hyperviscosity, which is induced multifactorially, 24,25 i.e., by pneumonia-mediated inactivation of surfactant, 26 systemic inflammatory response after cardiopulmonary bypass, 27,28 fluid restriction and diuretics 1 (despite the known beneficial effects, e.g., in acute respiratory distress syndrome 29,30 ), or by young age or mechanical ventilation (trauma) itself. 2 Sudden mucus mobilization episodes were slightly less frequent after dornase alfa treatment than in the group given placebo.…”

Section: Discussionmentioning

confidence: 91%

Recombinant Human Deoxyribonuclease Shortens Ventilation Time in Young, Mechanically Ventilated Children

Riethmueller

Borth-Bruhns

Kumpf

et al. 2005

Pediatric Pulmonology

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Summary. Recombinant human deoxyribonuclease I (dornase alfa) is currently used as an inhaled mucoactive agent in the treatment of cystic fibrosis. In a randomized, placebo-controlled, double-blind clinical study in 100 infants, we investigated whether the therapeutic use of dornase alfa can be extended to ventilated, fluid-restricted children to reduce reintubation rate, ventilation duration, pediatric intensive care unit (PICU) stay, and ventilation complications. While reintubation rates were similar for dornase alfa 7% vs. placebo 9% (odds ratio, 0.77; confidence interval, 0.11-4.9), the incidence of atelectasis (6 vs. 17, respectively; P-value 0.051), median ventilation time (2.2 vs. 3.4 days, respectively; P-value 0.043), median length of PICU stay (7 vs. 8 days, respectively; P-value 0.051), and mean costs (s4,830 vs. s6,320, respectively) were lower in the dornase alfa group. No adverse effects were observed, even in critically ill patients. We found that dornase alfa was beneficial and safe. Our findings also indicate that dornase alfa is possibly of value from the first day of mechanical ventilation onward, particularly when longer ventilation (>3 days) is expected in fluid-restricted children after cardiac surgery.

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Section: Discussionmentioning

confidence: 91%

Recombinant Human Deoxyribonuclease Shortens Ventilation Time in Young, Mechanically Ventilated Children

Riethmueller

Borth-Bruhns

Kumpf

et al. 2005

Pediatric Pulmonology

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“…6 Esta representa un signo de enfermedad, pero no sugiere per se un diagnóstico específico. El niño presenta una mayor predisposición al colapso pulmonar debido al menor tamaño de las vías aéreas, menor número de canales de ventilación colateral y una estructura torácica más distensible.…”

Section: Discussionunclassified

Broncoscopía flexible en niños con atelectasias persistentes. Serie de casos

2015

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Arch Argent Pediatr 2015;113(2):e106-e108 / e106Presentación de casos clínicos RESUMEN La mayoría de los niños con atelectasias pulmonares presentan una resolución completa con el tratamiento médico. En atelectasias persistentes, el tratamiento broncoscópico sería una alternativa terapéutica efectiva para lograr la resolución de esta patología. Objetivo. Describir nuestra experiencia al utilizar la broncoscopía flexible en niños con diagnóstico de atelectasia persistente. Resultados. Un total de 106 broncoscopías fueron realizadas por la Sección de Neumonología Pediátrica del Hospital Italiano entre enero de 2005 y diciembre de 2013, de las cuales 32 correspondieron a pacientes con atelectasia persistente. La mediana de edad fue de 5 años. La vía de abordaje más utilizada fue la máscara laríngea. En 28/32 pacientes, se logró una reexpansión completa o parcial. Los procedimientos fueron bien tolerados. Conclusiones. La broncoscopía flexible resultó ser una herramienta segura y de gran valor terapéutico para el tratamiento de esta serie de niños con atelectasias persistentes. Palabras clave: broncoscopía, atelectasia pulmonar, niños. ABSTRACTMost patients with pulmonary atelectasis have complete resolution with medical therapy. In patients with persistent atelectasis, endoscopic treatment has proven to be an effective therapy. Objective. To describe our experience using flexible fiberoptic bronchoscopy in children with persistent atelectasis. This is a case series report of children treated with flexible bronchoscopy between January 2005 and December 2013, at the Pediatric Pulmonology Section of the Hospital Italiano de Buenos Aires. Results. From a total of 106 bronchoscopies performed, 32 of the patients had a diagnosis of persistent atelectasis. Mean age, 5 years. Laryngeal mask airway was the most common route for flexible bronchoscopy. In 28/32 patients, the procedure was therapeutically useful (complete or partial re-expansion). The procedure was well tolerated and presented only mild complications. Conclusions. Flexible bronchoscopy proved to be a safe and effective tool for the treatment of children with persistent atelectasis.

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“…Bunun sebebi havayollarının daha küçük ve kollapsa daha yatkın olması, göğüs duvarının kompliyasının yüksek olması ve intraalveolar ve bronkoalveolar gözenekler aracılığıyla sağlanan kollateral ventilasyonun tam gelişmemiş olmasıdır. Neticede atelektazi yenidoğan yoğun bakım ünite-lerinde yaygın görülen bir komplikasyondur ve ek morbiditeye sebep olur (1). Postoperatif ağrı ise atelektazi oluşumuna katkı sağlar (2).…”

Section: Discussionunclassified

Treatment of Resistant Atelectasis After Esophageal Atresia Repair with rhdnase

Yilmaz¹,

Afşarlar²,

Ertürk³

et al. 2015

Turkish J Pediatr Dis

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ÖZETÖzefagus atrezisinin cerrahisi sonrası dirençli atelektazi gelişen hastaların tedavisinde rhDNase uygulanması daha önce literatürde bildirilmemiştir. Bu çalışmayla biz, özofagus atrezisi operasyonu sonrasında gelişen ve konvansiyonel yöntem-lerle düzelmeyen, sağ akciğer atelektazili iki olgunun rhDNase ile tedavi sonuçlarını sunmayı amaçladık.On beş günlük kız bebek özofageal atrezi ve distal trakeoözofageal fistül nedeniyle opere edildikten 11 gün sonra sağ akciğerinde atelektazi gelişti. Standart tedavilere cevap alınamadı. Postoperatif 20. gün rijit bronkoskopi yapıldı. Atelektazi kısmen açıldı ancak tekrar etti. 26. gün nebulüzatörle rhDNase tedavisi başlandı. 2 gün boyunca, günde 3 kez 1.25mg dozda rhDNase uygulandı. Her 3 dozluk tedavi sonunda kontrol akciğer grafileri çekildi. İkinci gün sonunda hastanın atelektazisinin tamamen düzeldiği görüldü ve tekrar etmedi.Özofageal atrezi ve distal trakeoözofageal fistül nedeniyle 3 günlükken opere edilen, 7 günlük erkek bebekte, sağ akciğerde atelektazi gelişti. Hastaya standart atelektazi tedavileri uygulandı, fakat atelektazide düzelme olmadı. Postoperatif 9.gün hastaya rhDNase tedavisi başlandı. Hastaya, ilk olguda uygulandığı şekliyle, 2 gün boyunca rhDNase tedavisi uygulandı. İkinci gün sonunda hastanın atelektazisinin tamamen düzeldiği görüldü ve tekrar etmedi.Özefagus atrezisi operasyonu geçirmiş yenidoğanlarda postoperatif gelişen dirençli atelektazilerin tedavisinde rhDNase alternatif olabilir.Anahtar Sözcükler: Dornaz alfa, Özefagus atrezisi, Postoperatif akciğer atelektazisi, rhDNaz, Yenidoğan ABSTRAcTThere is no previous literature report on the use of rhDNase treatment in patients developing resistant atelectasis after esophagus atresia surgery, to the best of our knowledge. We aimed to present the results of rhDNase treatment in two cases that developed right lung atelectasis after esophageal atresia repair and did not respond to conventional treatment.A 15-day-old girl was operated for esophageal atresia with distal tracheoesophageal fistula and developed right lung atelectasis on the postoperative 11th day. Standard conservative treatment failed and rigid bronchoscopy was performed on the postoperative 20th day. The atelectasis partly improved but subsequently recurred. We started nebulization with rhDNase on postoperative day 26 and three doses per day were administered for 2 days with each dose containing 1.25 mg of rhDNase. A chest X-ray was obtained at the end of the three doses. A full recovery in the patient's atelectasis was observed after 2 days and no recurrence occurred.A 7-day-old boy who underwent esophageal atresia with distal tracheoesophageal fistula repair when 3 days old developed right atelectasis. The patient received standard treatment but the atelectasis did not improve. The patient was treated with rhDNase for two days starting on the 9th postoperative day using the same dose as the first case. A full recovery in the patient's atelectasis was observed after 2 days and no recurrence occurred.We found rhDNase treatment to be...

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Atelectasis: mechanisms, diagnosis and management

Cited by 100 publications

References 10 publications

Recombinant Human Deoxyribonuclease Shortens Ventilation Time in Young, Mechanically Ventilated Children

Recombinant Human Deoxyribonuclease Shortens Ventilation Time in Young, Mechanically Ventilated Children

Broncoscopía flexible en niños con atelectasias persistentes. Serie de casos

Treatment of Resistant Atelectasis After Esophageal Atresia Repair with rhdnase

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