Post Op atelectasis Flashcards
Describe atelectasis
An abnormal condition of the lungs characterized by partial or total collapse of previously expanded alveoli
What is the result of atelectasis?
Reduced gas exchange in the collapsed lung units and reduced compliance
What are some common minor post operative pulmonary complication?
Atelectasis
Bronchospasm
Pneumonia
Acute upper airway obstruction
Exacerbation OSA
What are common (but more severe) post operative pulmonary complications?
Pleural effusion
Chemical pneumonitis
Pulmonary embolism
Abdominal compartment syndrome
Tracheal laceration or rupture
What factors increase a patients chance for developing post operative atelectasis?
Obesity
Operative and post operative supine positioning
Advanced age
Use of inadequate tidal volumes during mechanical ventilation
What are the “levels” atelectasis and how common are they?
Micro atelectasis/subsegmental atelectasis = very common
Segmental atelectasis = fairly common
Lobar atelectasis = uncommon
Entire lung collapse = very rare
What portions of the lung most commonly experience post operative atelectasis?
20-25% of lung tissue in the basal lung area collapses after induction with general anesthesia
What are the two types of atelectasis
Obstructive
Non-obstructive
Describe compression atelectasis
A “space occupying lesion” develops in the pleural space and puts pressure on lung units resulting in collapse
Describe obstruction atelectasis
Airway is obstructed, if collateral flow doesnt exist or is inadequate, the obstructed unit will collapse
Give some examples of compression atelectasis
Pneumothorax
Hemothorax
Pleural effusion
Describe relation atelectasis
Contact between the parietal and visceral pleura is lost and the elastic recoil of the lung pulls it inward collapsing the lung units
When could a patient experience relaxation atelectasis?
Pleural effusion
Pneumothorax
Loss of surfactant
Describe cicatricial atelectasis
Cicatrix = scar
Parenchyma becomes scarred and collapse as a result
What processes could cause cicatricial atelectasis?
Diseases that form granulomas (sarcoid)
Necrotizing pneumonia
Radiation pneumonitis
How is post operative atelectasis diagnosed?
Clinical diagnosis drawn from signs and symptoms and reinforced with imaging
Describe replacement atelectasis
Alveoli of lung units become filled with tumor tissue
How might a patient with post op atelectasis present?
Elevated vital signs
Cyanotic
Diaphoretic
What features of a chest assessment would indicate post op atelectasis?
Increased tactile or vocal fremitus
Dull percussion notes
Bronchial breath sounds
Diminished breath sounds
Crackles
Whisper pectoriloquy
What features or a CXR would indicate post op atelectasis?
Increased density in areas of atelectasis
Air bronchograms
Elevation of diaphragm on affected side
Tracheal or mediastinal shift toward the affected side
Increased density in areas of atelectasis
Air bronchograms
Elevation of diaphragm on affected side
Tracheal or mediastinal shift toward the affected side
Post op atelectasis
A patient with post operative atelectasis has relatively few secretions but is having trouble taking deep breaths. What treatment options would be best for them?
CPAP
A patient with post operative atelectasis has excessive secretions but is having trouble taking deep breaths. What treatment options would be best for them?
Airway clearance
ENT suctioning
Oral suctioning
OPEP
CPT
Bronch
A patient who has post op atelectasis from pleural effusions. What would be the best way to treat the atelectasis?
By treating the pleural effusions with either diuretics or a thoracentesis
