Post-Op Atelectasis

Question 1

What is atelectasis?

Answer 1

A partial collapse of the small airways

Question 2

How common is atelectasis?

Answer 2

The majority of post-op patients will develop some degree of atelectasis

Question 3

What can atelectasis result in?

Answer 3

Abnormal alterations in lung function or compromise to the lungs immune defences

Question 4

What is the pathophysiology of atelectasis?

Answer 4

Not fully understood, but current theories suggest that airway collapse is due to combination of airway compression, alveolar gas resorption intra-operatively, and impairment of surfactant production

Question 5

Why does atelectasis presuppose patients to developing pulmonary complications?

Answer 5

Due to reduced airway expansion and subsequent accumulation of pulmonary secretions

Question 6

What pulmonary complications are patients with atelectasis predisposed too?

Answer 6

• Hypoxaemia
• Reduced lung compliance
• Pulmonary infections
• Acute respiratory failure

Question 7

What does the degree of lung tissue involved in atelectasis depend on?

Answer 7

The underlying cause

Question 8

When are most cases of atelectasis seen?

Answer 8

In post-op period, typically developing within 24 hours of surgical intervention

Question 9

What are the main risk factors for post-op atelectasis?

Answer 9

• Age
• Smoking
• Use of general anaesthetics
• Duration of surgery
• Pre-existing lung or neuromuscular disease
• Prolonged bed rest
• Poor post-op pain control

Question 10

How will patients with post-op atelectasis present?

Answer 10

Varying degrees of respiratory compromise, with the most common clinical features being increased respiratory rate and reduced oxygen saturations

Question 11

What may be found on examination in post-op atelectasis?

Answer 11

• Fine crackles over affected pulmonary tissue
• Reduced oxygen saturation
• Sometimes low-grade fever

Question 12

How is a diagnosis of atelectasis usually made?

Answer 12

Normally clinical, especially in post-op patient who develops respiratory symptoms within 24 hours of surgery

Question 13

What may be found on CXR in atelectasis?

Answer 13

Small areas of airway collapse

Question 14

What can be done if CXR is inconclusive and warranting further investigation in post-op atelectasis?

Answer 14

CT

Question 15

What is found on CT in atelectasis?

Answer 15

Airway collapse and reduced airway volume

Question 16

What is the most effective treatment for post-op atelectasis?

Answer 16

• Deep breathing exercises
• Chest physio
• Pain control

Question 17

Why are deep breathing exercises and chest physio important in post-op atelectasis?

Answer 17

Ensures airways are opened maximally and coughing can be performed effectively

Question 18

Why is pain control important in post-op atelectasis?

Answer 18

Allow patient to deep breathe

Question 19

What should be done if no significant improvement is seen following physiotherapy in post-op atelectasis?

Answer 19

Bronchoscopy to aid in suctioning out pulmonary secretions

Question 20

How can post-op atelectasis be prevented?

Answer 20

All patients who have undergone major surgery should be referred to receive chest physiotherapy as a preventative measure