Treatment of atelectasis where is the evidence 英文参考文献.docVIP

Available online /content/9/4/341 Commentary Treatment of atelectasis: where is the evidence? Margrid B Schindler Consultant in Paediatric Intensive Care, Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK Corresponding author: Margrid B Schindler, Margrid.Schindler@ubht.swest.nhs.uk Published online: 7 July 2005 Critical Care 2005, 9:341-342 (DOI 10.1186/cc3766) This article is online at /content/9/4/341 ? 2005 BioMed Central Ltd See related research by Hendriks et al. in this issue [/content/9/4/R351] Abstract bronchodilators [3], fibreoptic bronchoscopy [4], DNase [1], positive end-expiratory pressure [5] and surfactant [6]. Lobar atelectasis is a common problem caused by a variety of mechanisms including resorption atelectasis due to airway obstruction, passive atelectasis from hypoventilation, compressive atelectsis from abdominal distension and adhesive atelectasis due to increased surface tension. However, evidence-based studies on the management of lobar atelectasis are lacking. Examination of air- bronchograms on a chest radiograph may be helpful to determine whether proximal or distal airway obstruction is involved. Chest physiotherapy, nebulised DNase and possibly fibreoptic broncho- scopy might be helpful in patients with mucous plugging of the In passive and adhesive atelectasis, positive end- expiratory pressure might be a useful adjunct to treatment. Chest physiotherapy is the traditional first-line therapy for atelectasis [4]; however, even for this basic therapy, evidence is lacking: there are only two published studies [7,8]. In 57 ventilated children, chest physiotherapy with saline lavage and simulated cough was successful in improving lung expansion in 84% of patients [7]. If physiotherapy fails, further examination of the chest radiograph to identify the level of air bronchogram may be helpful to ide