What Is Atelectasis?

Atelectasis is a condition when a part or a lobe ( segment ) of the lungs in a person doesn't work. In Atelectasis, the air sacs ( alveoli ) in the lungs deflate, interfering with respiratory function. The magnitude of alveolar tissue damage due to atelectasis varies, depending on the cause. In patients who already have respiratory diseases, the emergence of atelectasis can exacerbate the difficulty of breathing, as well as lowering oxygen levels in the blood. Based on its physiological character, atelektasis is divided into two types:

• Obstructive atelectasis. This is the most common type of atelectasis. Obstructive atelectasis arises from the channel between the trachea (throat) with the blocked alveoli, so that the carbon dioxide gas that should be removed is reabsorbed by the blood in the alveoli. Obstruction that occurs in obstructive atelectasis can be caused by tumors, foreign bodies, or mucosal mucous blockage. Obstruction in obstructive atelectasis can occur in large bronchi (lobular) and small bronchi (segmental).
• Non-obstructive atelectasis. Atelaxis of this type can be subdivided into several sub types, including:
• Relaxation atelectasis. This condition occurs due to the membrane in the lung (pleural visceral) loss of contact with the outer membrane of the lungs (pleura parietalis), either because of fluid ( pleural effusion ) or air ( pneumothorax ) in the pleural space.
• Compression atelectasis. This condition occurs due to the appearance of lesions in the chest cavity that suppress the lungs and push air out of the alveoli, thus reducing the volume of the lungs.
• Adhesive atelectasis. This condition occurs due to lack of surfactant in the lungs. Surfactant in the lungs serves to reduce surface pressure on the alveoli. Lack of surfactant can lead to deflation of the alveoli.
• Atelectasis sikatrik. In this condition, reduced alveoli volume is due to damage or injury to the alveoli wall due to granulomatous disease or pulmonary necrosis.
• Atelectasis replacement . This atelectasis occurs as a result of alveoli in all segments of the lung filled or replaced by tumor cells, for example in bronchioalveolar cell carcinoma, so that the air volume in the lungs decreases.

Symptoms of Atelectasis
The symptoms that appear in atelectasis are difficult to observe because they do not appear quickly. The symptoms of atelectasis that occur depend on the size of the lung affected by atelectasis, the presence of blockage in the bronchus, or the presence of infections that can aggravate atelectasis. In general, atelectasis symptoms can be:

• Difficult breathing (dyspnea).
• Cough.
• Short and short breath.

If atelectasis results from blockage or blockage of the bronchi, the following symptoms may develop:

• Pain in the affected area atelectasis.
• Dyspnoea that occurs suddenly.
• Cyanosis, which is bluish on the skin, lips, and fingertips due to lack of oxygen.
• Increased heart rate (tachycardia).
• Low blood pressure (hypotension).
• Fever.
• Shock.

Slowly developing atelectasis is generally asymptomatic or causes mild symptoms only.

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Causes of Atelectasis
Atelectasis often occurs after the use of anesthesia for surgery. Anesthesia used at the time of surgery can cause changes in the breathing pattern, as well as the absorption of foreign gas and pressure on the lungs. The condition can cause the alveoli to deflate and cause atelectasis. Besides being caused by anesthesia, the cause of atelectasis may also vary, in both obstructive and non-obstructive atelectasis cases.

Here are some factors that can cause obstructive atelectasis:

• Blockage of fluid mucus. Obstructive atelectasis may occur due to mucus clots or mucus fluid which causes airflow from the trachea to the alveoli to be disrupted. Mucous fluid blockage often occurs during surgery because the accumulation of mucus fluid can not be excreted through coughing or vomiting. Mucus fluid obstruction may also occur in children, cystic fibrosis, or in people with severe asthma.
• Foreign object. Obstructive atelectasis is very common in children who inadvertently suck foreign bodies such as nuts or toys and enter the lungs.
• Narrowing of the bronchial airways. Chronic infections such as fungal infections, tuberculosis (TB) and other diseases can injure and narrow the bronchi.
• Tumors in the large bronchial tubes. Tumors that grow in the airways of the bronchi can block airflow.
• Blood clots. If there is bleeding in the lungs and the patient can not release the blood, clotting can occur and block the flow of air into the alveoli.

Just as in the case of obstructive atelectasis, factors causing non-obstructive atelectasis are also variable, but dependent on the type.

Relaxation atelectasis can be caused by:

• Pleural effusion, the appearance of fluid in the lungs.
• Pneumothorax.
• Emphysema bullosa.

Compression atelectasis can be caused by:

• A lump on the wall of the chest muscle, the lung membrane, or within the lung parenchyma tissue.
• Clumps of fluid on the lining of the lungs.

Adhesive atelectasis can be caused by:

• Hyaline membrane disease.
• Acute respiratory distress syndrome (ARDS).
• Inhale smoke or cigarettes.
• Bypass operation
• Uremia, ie increased levels of urea in the blood due to kidney failure.
• Short, prolonged breathing.

Sikatrik atelectasis can be caused by:

• Idiopathic pulmonary fibrosis.
• Chronic tuberculosis.
• Fungal infections.
• Fibrosis radioactive

Other causes of non-obstructive atelectasis include trauma to the chest, such as those caused by traffic accidents that trigger a person to breathe rapidly and experience pressure on the chest. Wound in the lung tissue can also cause non-obstructive atelectasis, mainly from lung disease or surgery.

Things that cause a person more susceptible to atelektasis include:

• Atelectasis is more likely to occur in children under 3 years and older people over 60 years.
• Has conditions that interfere with lung activity, such as coughing, sneezing and yawning.
• Too much activity in bed without often changing body position.
• Having a food swallow disorder, especially in adults or elderly.
• Has lung disease. Examples are asthma, bronchiectasis , and cystic fibrosis .
• Born with a premature condition.
• Getting general anesthesia.
• Get surgery on the abdomen or chest.
• Suffers from a variety of conditions that cause shortness of breath.

Diagnosis of Atelectasis
Diagnosis not only focuses on determining the presence of atelectasis, but also determines the underlying cause of the condition. For this purpose, the following inspection methods can be performed:

• Chest X-ray. The use of X-ray images on the chest can detect the presence of atelectasis, especially if caused by foreign objects that often occur in children.
• CT scan. This type of scan can diagnose atelectasis better and more accurately, due to its ability to measure volume across the lung segment. CT scans can also detect the presence of tumors that are likely to cause atelectasis in patients.
• Oxymetry The oximeter instrument is clipped to the fingertips to measure the oxygen levels in the blood.
• Bronkoskopi. This method serves to show the inside of the lungs using a visual tool in the form of flexible thin hose. Bronchoscopy may also be used to remove some of the obstruction in the respiratory tract leading to atelectasis.
• Histology or tissue examination. Visual findings using bronchoscopy can be followed by tissue sampling to be analyzed using a microscope, for example to see any malignancy (cancer) or to blockage by the mucosa due to an allergic reaction to Aspergillus.

Atelectasis Treatment
The treatment of atelectasis will depend on the cause. Light atelectasis can heal by itself without treatment. If atelectasis is caused by a disease or condition, then treatment will be focused on the underlying problem. For example, if atelectasis is caused by a tumor, atelectasis treatment will also involve chemotherapy or surgery to remove the tumor.

Atelectasis caused by postoperative complications can be treated gradually through chest and respiratory physiotherapy. The chest and respiratory techniques of chest and respiratory therapy provided serve to help the alveoli recover after the surgical deflection. Steps of therapy are given:

• Train coughing techniques to remove mucosal fluid.
• Patted the chest on the part that suffered from atelectasis to relax the alveoli muscle. For the purpose of alveoli muscle relaxation, a tool for cleaning mucosal fluid can also be used.
• Exercise deep breathing techniques, which can be helped using incentive spirometry tools. This exercise can be combined with cough training techniques to remove mucosal fluid.
• Position the head lower than the body in order to help remove more mucosal fluid than before.

In obstructive atelectasis patients diagnosed through bronchoscopy, the physician can immediately perform a procedure to remove obstruction in the respiratory tract. This obstruction removal procedure can be done by sucking the mucosal fluid using bronchoscopy.

To aid the treatment and cure of atelectasis, patients may be given the following medications:

• Bronchidilators Bronchidilators serve to lower muscle tension in the bronchus, bronchioles, and alveoli so that airflow in the respiratory tract can be increased. Examples of this class of drugs are albuterol and metaproterenol .
• Antibiotics. At atelectasis caused by infections that cause obstruction in the bronchus, can be given broad-spectrum antibiotics. Examples of antibiotics that can be given are cefuroxime and cefacior .
• Mukolitics . Mukolitik class drugs function to reduce the viscosity of mucus making it easier to remove through the respiratory tract. Examples of this class of drugs are N-acetylcysteine and alpha dornase.

Atelectasis Complications
If atelectasis is not treated properly, the following complications may arise:

• Hypoxemia. Hypoxemia is a condition when the blood is oxygen deprived. This is because atelectasis inhibits the ability of the lungs to supply oxygen through the alveoli.
• Pneumonia . Atelectasis, particularly obstructive atelectasis due to mucus fluid, may lead to infection, and one of them is pneumonia. Not only that, if pneumonia occurs, then the risk of sufferers to get sepsis also exist.
• Respiratory failure. Atelectasis can still be treated if it occurs only in a small part of the lung. However, if atelectasis has spread to one segment or even to all parts of the lung, especially in patients with lung disease or young children, it can lead to respiratory failure or even death.
• Bronchiectasis. Bronchiectasis is a lung disease caused by permanent damage, thickening, and dilation of the bronchial tubes.

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