نبذة مختصرة : 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 Case Report A 58-year-old female presented to our hospital with lower extremity weakness. She was intubated and mechanically ventilated for impending respiratory failure. She was placed on assist-controlled ventilation, with a tidal volume of 7 ml/kg PBW, respiratory rate of 16 breaths/minute and a PEEP of 7.5 cmH 2 0. The FiO 2 was titrated to keep the arterial saturations greater than 92%. Physical examination revealed an obese female (BMI 48.8 kg/m 2 ) sedated on the ventilator. Vital signs were within normal limits. Lung exam revealed near absent breath sounds and dullness to percussion on the right. A chest radiograph demonstrated right lung collapse. Computed tomography of the thorax showed right lung collapse, a "small" pleural effusion and near complete destruction of the 8 th thoracic vertebral body. Chest physiotherapy, endotracheal suctioning and fi beroptic bronchoscopy were attempted without radiologic improvement. This was followed by a recruitment maneuver (performed on the ventilator) followed by chest physiotherapy and suctioning again without success
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