P1: SBT
0521779407-04a CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:48
178 Atelectasis
RR: 10–12
PEEP: 5–10 cm H 2 O
Pressure support: 5–10 cm H 2 O
■Bronchoscopy:
➣Relatively ineffective if plug distal to mainstem bronchus
➣Reserve for life-threatening hypoxia with complete lung collapse
(suggestive of treatable plug at mainstem bronchus)Side Effects & Complications
■PEP/CPAP/BiPAP:
➣Inadequate delivery of positive pressure support
➣Pressure leak around mask
➣Gastric insufflation with aspiration
➣Pressure necrosis of nose and mouth by continuous mask pres-
sure
➣Agitation requiring sedation
■Aerosol therapy: bronchospasm
■Percussion therapy: rib fracture
■Nasotracheal suction: epistaxis, bronchospasm, emesis, aspirat-
ion
■Endotracheal intubation:
➣Esophageal intubation
➣Failure to intubate trachea after suspending respiration with neu-
romuscular blocking agents
➣Mainstem bronchial intubation with intrapulmonary shunt
➣Agitation requiring sedation
➣Hypotension due to decreased venous return
➣Regurgitation and aspiration of gastric contents
➣Nosocomial pneumonia
➣Bronchoscopy: pneumothorax, bronchospasm
■Contraindications
➣Absolute:
Nasotracheal suctioning: coagulopathy, recent pharyngeal
surgery
PEP/CPAP/BiPAP: severe GE reflux, recent pharyngeal surgery,
severe agitation and poor cooperation
Percussion therapy: rib fracture
Endotracheal intubation: none
➣Relative:
PEP/CPAP/BiPAP: obesity, depressed consciousness, GE re-
flux, nasogastric nutrition