atelectasis

[billyvega]

bromhexine inhalation for atelectasis

what do you think?

[manuel perez valdez]

i don't have any experience with bromhexina, but i think is like ambroxol or n-acetilcystein with same idea.

[Guest mbayari]

In the 1990s, Ambroxol have been used in these indications,and others, because authors assimilate it to surfactant. I would like just remind you that atelectasis is a mechanical problem in that, newborns, term or preterm ones, are lacking Lambert and Kuhn channels that allow alveoli to communicate and "breath" with each other. So, if something have to be done in babies suffering atelectasis, is physiotherapy and a good hydration.

[manberbenitez]

Dear Carlos Valdes:

I have to write you in english, because this is an international forum, The use of ambroxol wasa classical therapeutic method from europe ( Italy), basically for RDS via IV, but when we dont have surfactant I saw 4 or 5 cases of intersticial emphysema.Ambroxol inhalation is not common in neonatology, and probably you could havea lot of secretion production so its not so good, I agree with Mohamed Mayari MD, that the best way to treat atelectasis is to prevent it, and you should have to give a good physiotherapy, IV requirements liquids, humedification and heated air, and change regulary the position of the baby, and obviously a good caloric intake to have a good mechanical chest properties. Be carefull with a infection, because some time there is a endobronchitis and infection association. In some cases a short course of steroids could be fine, and probably in the more difficult cases, pulmozyme, could work very good, but is too expensive. Nice to meet you and hope this help you.

[Guest mbayari]

Dear Manuel

Thanks for your comment. I agree with your point of view. Effectively, in the 1990s, as I told it, ther was a tendancy of certain teams, mainly italians, to introduce Ambroxol as a therapeutic tool in NICUs. Authors postulated that Ambroxol can enhance the tourn-over of natural surfactant (I was a resident followship at this time and my head chief asked me if I would be interested in a lecture or paper about that).

I would like to mitigate your use of Pulmozyme (rhDNAse): the sole recommendation, at my knowledge, is for cystic fibrosis; do you have any experience to learn us in other conditions?

In difficult cases, we manage to perform an endospcopic BAL that would have a therapeutic indication bu also a diagnostic one (obstruction, granuloma, extrinsic compression...).

Hope this will help you dear Carlos Valdes.

[Skysurfer]

Hi everybody,

How would you apply the bromhexine or any other medication to the lungs?

Every method that i know is in need for a disconnection of the Ventilator Circuit before and after the Inhalation. So even if inhaling medications would have a beneficial effect, one would destroy this "short" effect by disconnecting the Vent. Circuit after Inhalation. Isn´t that correct?

The only way i know to treat and prevent a Lung from atelectasis is to open the lung and keep it open by maintaining a normal FRC. Physiotherapy and various positioning techniques should help just as well.

[manuel perez valdez]

yes, i agree to open the lung and keep it open is the goal, and the physiotherapy with IPPV to provide inhalated steroids it's works.

[Skysurfer]

Dear Colleagues,

I would be curious to know if anyone of you is using Albuterol (Ventolin) to treat children with severe respiratory secretions and atelectasis. I have noted an increase of this method during the past years, but i am not quite sure if this method works!?

As far as i am informed the only cure against mucus is humidified, warmed air, physiotherapy,and administration of enough fluid. Ventolin has no qualities in thinning musus or enhancing the situation of the atelectated lung areas.....

What is your opinion regarding that matter?

Any thoughts are appreciated

Cheers Norbert

[Guest mbayari]

Hi all

Some papers recently have postulated, but badley at my thought,that bronchodilators may help aginst atelectasis; those are almost from physiotherapists who believe, wrongly, that "dilating" bronchus may help evacuating thin mucus. This is not in ageement with physiological background of atelectasis. I agree with Norbert that first we have to open and keep open the lung and, if it happens uneventfully, we can help using humidified, warmed air, physiotherapy and enough fluids.