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Atelectasis of the lungs: causes, symptoms, treatment

Scheme-atelectasis-lung Atelectasis is a pathological condition of the lung tissue, in which it falls off and loses airiness.Because of this, the working respiratory surface of the lung decreases, as a result - the respiratory function suffers: gas exchange worsens, oxygen starvation of tissues and over-saturation of the body with carbon dioxide increase.

If atelectasis affects the lower lobes of the lungs, their respiratory function is reduced by 20%.The defeat of the average lobe is not as critical and results in a 5% deterioration in breathing.

Table of contents:

Causes of lung atelectasis

The appearance of atelectasis can provoke any factor that prevents air from entering the lungs and spreading it.These are:

  • Leghkie any causes leading to a narrowing of the bronchus lumen;
  • violation of the integrity of the walls of the bronchus with a one-time rapid mechanical effect on it;
  • collapse of lung tissue( a decrease due to its own pathology);
  • congenital malformations of the respiratory system;
  • causes the depression of the respiratory center in the brain.

Narrowing of the bronchus lumen may occur:

  • due to obstruction of the lumen from the inside;
  • because of pressure from the outside.

Blocking of the bronchus lumen can occur:

  • by a foreign body( due to choking, inadvertent inhalation or unconscious pushing into the respiratory tract of an object, the latter being capable of patients with psychiatric clinics);
  • accumulated mucus or pus formed due to pathological processes in the wall of the bronchus;
  • vomit.

Narrowing the lumen of the bronchus can exert pressure on it from the outside:

  • lymph nodes enlarged due to inflammatory or tumor process;
  • is a nearby tumor( in most cases it is a lung lesion).

Due to the fact that as a result of blockage or pressure on the bronchus, it reacts with reflex bronchospasm( thus reducing the smooth muscles of the bronchi), narrowing of the airways is aggravated even more.

The violation of the integrity of the walls of the bronchus due to mechanical effects on it is observed:

  • during an operative intervention, when the bronchial bandaging is practiced as a method of treatment for tuberculosis of the lungs;
  • in case of a chest injury causing bronchus rupture.

Collapse of lung tissue can be caused by the following reasons:

  • Leghkie reduced air pressure in the alveoli( vesicular structures that make up lung tissue);This can occur due to a violation of the technique of introducing the patient into anesthesia;
  • sharp pressure drop of ambient air;This condition often happens in fighter pilots;
  • decrease in the amount of surfactant - a substance that is produced in the alveoli and keeps their walls in proper tonus;A typical example in which the production of surfactant suffers - the respiratory distress syndrome of newborns;
  • increased pressure within the lung tissue in comparison with intra-alveolar pressure;It happens with pulmonary edema;
  • mechanical pressure on the tissue of the lung.

Mechanical pressure on the pulmonary parenchyma can be performed by: any

  • Leghkie
      Leghkie any abnormal contents that is in the pleural cavity - blood, serous effusion( watery discharge), pus or air;
  • increased as a result of any heart disease;
  • large aneurysm( local enlargement) of the thoracic aorta;
  • large area of ​​tuberculosis lesions of lung tissue.

Depression of the respiratory center in the brain can occur when:

  • craniocerebral trauma with lesion of the medulla oblongata in which the respiratory center is located;
  • brain tumors;
  • anesthesia( both inhalation and intravenous);
  • supersaturation of brain tissue with oxygen;Can happen with excessive oxygen supply during artificial ventilation;
  • overdose of drugs with sedative( calming) effect.

Congenital malformations of the respiratory system:

  • bronchial underdevelopment;
  • the presence of tendon septa, which form intrabronchial valves and interfere with the movement of air;
  • fistulas( pathological courses) between the esophagus and the trachea;
  • developmental defects of soft and hard palate( eg, "wolf mouth").

Also highlighted are factors that greatly aggravate atelectasis of the lungs, for whatever reason it might be:

  • smoking;
  • overweight;
  • bronchial asthma;
  • cystic fibrosis( genetic pathology, in which, in addition to other organs, the bronchi are affected).

How the pathology develops

Atelectasis happens:

  • primary( congenital);
  • secondary( purchased).

Congenital atelectasis is seen in newborn infants, when the first inhalation does not fully complete and inflate the lungs with air. Reasons for this atelectasis:

  • intrauterine malformations;
  • lack of surfactant;
  • ingestion of amniotic fluid or meconium( an analogue of feces released by the fetus during intrauterine development).

Acquired atelectasis occurs at different ages due to the causes described above.On the development mechanism, it happens:

  • obturative( due to bronchial blockage);
  • compression( due to external pressure on the respiratory tract)
  • functional( in the case when the "ventilation" of the lungs decreases, but pathology as such is not observed);
  • mixed.

Leghkie The degree of atelectasis due to obstruction depends on whether the bronchus lumen is occluded partially or completely. If a blockage occurs, the patency of the bronchus should be restored immediately. The matter is not only in the sharply arisen oxygen starvation of the body due to the decrease in oxygen supply: the longer air does not get through the bronchus into the asleep fragment of the lung, the more likely that this site will stick together and not be straightened.If the lumen of the bronchus is completely blocked for more than 3 days - ventilation in the corresponding area of ​​the lung does not recover.

Atelectasis due to pressure on the lung tissue has a more favorable outcome than that due to blockage.Even after a long period of contraction of the lung, there is a chance of complete recovery of lung ventilation.

Functional atelectasis develops in the lower parts of the lungs.It occurs in the following cases:

  • Leghkie in bedridden patients - most often with a long postoperative period, after strokes, spine injuries, in patients in coma and so on;
  • if an overdose of sedative( sedative) drugs or barbiturates( used to inhibit the nervous system);
  • with restricting breathing to reduce pain( chest injuries, pleural inflammation, acute surgical diseases of the abdominal organs);
  • because of increased intra-abdominal pressure, promoted by constipation, ascites( loose fluid in the abdominal cavity), bloating;
  • with paralysis of the diaphragm;
  • because of certain diseases of the spinal cord.

Mixed atelectasis occurs due to the summation of the various causes described above.

The severity of atelectasis depends on the level of blockage of the bronchus and the area of ​​the lung recession - its degree varies from lobular atelectasis, when the terminal bronchioles suffer( the smallest bronchi), before the entire lung falls off, when the main bronchus is involved in the pathological process.

Symptoms of lung atelectasis

Intensity of signs of atelectasis depends on such reasons as:

  • rapidity of falling lung tissue( distinguish between acute and gradually increasing atelectasis);
  • the volume of the lung respiratory surface that was turned off from the breathing process;
  • localization of the fall;
  • development mechanism.

The main signs on which it is possible to suspect the occurrence of atelectasis are:

  • dyspnea;
  • chest pain;
  • discoloration of the skin;
  • change in parameters from the cardiovascular system;
  • worsening the general condition of the patient.

Dyspnea with atelectasis occurs as compensation for the fact that the asleep portion of the lung does not work, and the body tries to maintain ventilation at the same level by increasing the number of respiratory movements. Breathing in dyspnea:

  • rapid;
  • surface;
  • may be unstable.

First, dyspnea appears with any physical exertion, when the body needs an additional portion of oxygen, and then at rest.At rest, dyspnea may occur immediately if atelectasis has amazed a large volume of the lung.

Pain in the thorax with atelectasis is not observed in every case, therefore it is not a particularly valuable diagnostic feature of the . Pain syndrome occurs when air enters the pleural cavity.

The color of the skin changes because of the excess of carbon dioxide in the tissues, because it does not have time to be excreted because of the deteriorated work of the asleep lung.Thus it is observed:

  • blueing of the nasolabial triangle in children;
  • blueing of the fingertips and tip of the nose in adults( acrocyanosis).

Violations from the sides of the cardiovascular system allow not only to detect the occurrence of a decline in the lung( or lungs), but also in combination with other symptoms to assess the degree of its development.These are the following changes:

  • Leghkie pulse is accelerated almost immediately after an atelectasis of the lung;
  • changes in blood pressure are very indicative: first it rises for a short time, then it decreases, developing proportionally to the severity of the decline in lung tissue;
  • less often - pain from the heart due to atypical location: the heart shifted towards the asleep lung, because as a result of the fall some of the space in the chest cavity was released.

The worsening of the general condition of the patient is due not so much to oxygen starvation of tissues as to the excess of carbon dioxide. Observed:

  • general weakness, which is felt subjectively not only with activity, but also in a passive state - sitting or lying down;
  • malaise;
  • dizziness( due to the sensitivity of the brain tissue to oxygen starvation).

Symptoms of atelectasis of the lungs in children

Small children have the same symptoms as adults, but they also have signs that are very characteristic of atelectasis in infants( newborns):

  • LeghkieAt the time of inspiration, the intercostal spaces are clearly drawn in, which is observed from the side of the lungs affected by atelectasis;
  • on inhalation there is a retraction of the sternum, which returns to the usual place during exhalation - there is a typical "migration" of the sternum associated with the act of breathing.

Diagnostics

Phondoskop Clinical symptoms that occur with lung atelectasis are not specific for this condition, therefore, for only shortness of breath, palpitations and hypotension, it is not possible to suspect atelectasis . This symptomatology allows you to suspect the presence of pathology on the part of the respiratory system as a whole, and it will be possible to specify it later in the examination of the patient - both physical( examination, tapping of the thorax by a doctor, listening to a phonendoscope), and using instrumental diagnostic methods.

An experienced physician suspects a drop in the lungs on the basis of an examination: the patient's chest will be asymmetric in respiratory movements due to the fact that her affected half does not move, because the lung actually does not breathe( figuratively speaking, he has nothing to breathe).

Without the use of additional instrumental methods for diagnosing lung atelectasis, it can be suspected with concomitant signs such as:

  • Leghkie dyspnea;
  • blue fingertips and nose;
  • general power failure;
  • lagging of the sick half of the chest in the act of breathing;
  • the presence of a disease that could lead to bronchial obstruction or pressure on the lung tissue( foreign body in the bronchus, fluid or air in the pleural cavity, intense tuberculosis, swelling in the chest cavity, and so on).

As in most cases atelectasis appears against the background of already existing diseases or pathological conditions, such a double negative impact on the body makes it even worse.

In some cases, due to the fact that many small areas of lung tissue fall off, atelectasis does not manifest in any way. But the areas of decline can become a place of origin of the foci of pneumonia - in such cases it is by focal pneumonia that an experienced physician suspects that the patient begins atelectasis, which then pours out into a severe lung lesion.

In most cases, without the use of additional instrumental research methods, confirming lung atelectasis is not possible with . The most useful for diagnosing this pathology are:

  • X-ray examination of the lungs and mediastinum( groups of organs that are located between two lungs);
  • computed tomography, which will allow a more detailed study of the airiness of the lungs;
  • bronchoscopy, with which you can determine the extent of the bronchial lesion - namely how the negative factors affected the decrease in its lumen.

Bronchoscopy

During instrumental diagnostic manipulation, it is important not only to establish the presence of atelectasis and its precise localization, but also to specify the volume of the asleep tissue in order to determine the correct treatment tactics and the amount of therapeutic manipulations.

The condition of not only the lung tissue, but also the roots of the lungs, ribs, mediastinal organs, the dome of the diaphragm, the pleura, the pleural cavity and even the spine is important for the diagnosis of atelectasis( a scoliotic deviation in the direction of the bulge towards the affected lung will be observed).

Treatment of lung atelectasis

Treatment of atelectasis is:

  • Elimination of the cause that caused it;
  • artificial lung ventilation;
  • correction of acid-base balance of blood, changed due to imbalance between oxygen and carbonic saturation of blood;
  • antibiotic therapy;
  • therapy aimed at eliminating the syndromes that inevitably occur with atelectasis;
  • physiotherapy.

Eliminating the causes of atelectasis is a very wide range of activities.

With atelectasis, which occurred as a result of bronchial obstruction, such medical manipulations as

  • bronchoscopy with transbronchial extraction of foreign body;
  • bronchoscopy with aspiration of mucopurulent contents, subsequent washing of bronchi with antiseptics and treatment and prophylactic administration of antibacterial drugs;
  • catheterization of the bronchi( temporary presence in the bronchi of a hollow tube, through which the suction of pathological contents clogging the bronchi is performed);
  • if the patient's condition allows - postural drainage by a natural method( with the help of expectoration or an artificially induced cough, while the patient should lie on a healthy half of the chest).

When atelectasis occurs due to compression of the lung tissue, perform such medical manipulations as:

  • puncture of the thoracic wall with a needle in the pleural cavity( pleural puncture), is performed with the purpose of sucking out the effusion, blood, pus or liquid;
  • operative treatment of tumors of the lungs and lymph nodes, elimination of cysts, abscesses, in some cases - tuberculosis foci.

With the development of physiological atelectasis, its course can not be neglected. For its elimination, the following are performed:

  • respiratory gymnastics under the supervision of a physician;Thus creating a high intrabronchial pressure( for example, by inflating balloons);
  • inhalation mixture of air and 5% carbon dioxide in order to stimulate the work of the respiratory center.

ventilation Artificial ventilation is performed when respiratory failure occurs.In some cases, it is practiced not only to saturate tissues with oxygen, but also for the timely spreading of the lungs, which after some time from the onset of the decline itself can no longer come on.

To correct the acid-base balance of blood, intravenous infusion drip solutions are prescribed, which compensate for the shortage of certain elements of the blood.Transfusion is performed taking into account the results of biochemical blood analysis.

When a sleeping lung is often attached infection.Therefore, antibiotic therapy is performed for:

  • treatment of infectious disease;
  • prevention of infectious complications( bronchitis, pneumonia, pleurisy).

Posindromnaya therapy is the elimination of various manifestations and consequences of atelectasis.Assign:

  • painkillers - with pain syndrome caused by retraction into the pleura process;
  • preparations for normalization of the cardiovascular system.

Physiotherapy is used to prevent and repair the consequences of atelectasis - specifically for:

  • for improving blood circulation;
  • prevents the occurrence of scar changes in the lungs.

To this end, use:

  • in the acute phase of the disease - UVF-irradiation;
  • in a subacute phase - a vibrating and usual massage to facilitate the departure of sputum and mucus discharge bronchi;
  • in the stage of recovery - electrophoresis with the use of drugs.

Prevention

Preventative measures include numerous activities that will help to eliminate the causes of atelectasis, or at least reduce the harmful effects of provoking factors.These are:

  • smoking quitting;
  • a healthy lifestyle with the right mode of work, rest, sleep and nutrition, which significantly reduces the risk of oncology of the chest;
  • cure inflammatory processes of the bronchi and lungs( as a consequence, regional lymph nodes will not grow);
  • the correct dosage of sedatives and barbiturates;
  • correct introduction of the patient into anesthesia during surgery

and many others.

Forecast for lung atelectasis

Sudden, rapidly increasing atelectasis of even one lung that has developed as a result of air ingress into the pleural cavity( with trauma, during surgery), results in a fatal outcome.

Atelectasis, which develops as a result of compression of the bronchi, with delayed care is characterized by a complex prediction.

The prognosis for the physiological and favorable atelectasis-mediated compression is . To worsen the prognosis in such cases can joined pneumonia.

Kovtonyuk Oksana Vladimirovna, medical reviewer, surgeon, medical consultant


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