Acute lobar atelectasis during mechanical ventilation: To beat, suck, or blow?

We describe a patient with lobar atelectasis who was successfully treated with airway pressure release ventilation (APRV) after failed attempts at recruitment with endotracheal suctioning, chest therapy, and bronchoscopy. We review the literature on the effectiveness of the various methods to treat lobar atelectasis. Mechanically ventilated patients have an ineffective cough reflex and are unable to adequately deal with their respiratory sections. Atelectasis is therefore a common problem in these patients. The risk of atelectasis may be increased with the widespread use of a lung protective strategy utilizing low tidal volumes (6 ml/kg IBW). (1) Atelectasis may worsen hypoxemia through shunting and may predispose to nosocomial pneumonia. Traditionally the treatment of atelectasis in mechanically ventilated patients has centered on chest therapy (slapping, beating and vibrating) and endotracheal suctioning. (2) When this fails, bronchoscopy and/or recruitment maneuvers are attempted. (3) We describe the successful use of airway pressure release ventilation (APRV) for the treatment of atelectasis in a patient who failed the traditional treatment modalities.