Resp Flashcards
Atelectasis
Partial collapse of the small airways and mucus plugging
Common post general anaesthesia
Pathophysiology of atelectasis
- airway compression
- alveolar gas resorption intra-operatively
- impairment of surfactant production
Therefore reduced airway expansion and build up of secretions
Complications of atelectasis
Hypoxaemia
Reduced lung compliance
Pulmonary infections
Acute respiratory failure
Risk Factors of atelectasis
Age
Smoking
Use of general anaesthesia
Duration of surgery
Pre-existing lung or neuromuscular disease
Prolonged bed rest (especially with limited position changes)
Poor post-operative pain control (resulting in shallow breathing)
How does anaesthesia cause atelectasis
increased mucus production and decreased mucociliary
clearance
Presentation of pulmonary atelectasis
- within first 48hrs
- Mild pyrexia
- Dyspnoea and tachypnoea
- Dull bases with decreased air expulsion
- Reduced sats
- Fine crackles
Management of pulmonary atelectasis
- Good analgesia to aid coughing
* Chest physiotherapy - deep breathing exercises
Risks of intubation
Aspiration pneumonia due to:
- neuromuscular agents
- Regurgitation
- damage to trachea
Common sites of aspiration pneumonia
Right middle and lower lobe
Bacteria causing aspiration pneumonia
Haemophilus Influenzae
Streptococcus pneumoniae
Staph aureus
Pseudomonas aeruginosa
Ix for atelectasis
Clinical
CXR
Prevention of atelectasis
Patients who have major surgery - referred for chest physiotherapy
Why does surgery increase the risk of pneumonia
Reduced chest ventilation – reduced mobility so inability to fully ventilate lungs
- accumulation of fluid secretions
Change in commensals
Co-morbidities compromising immune system
Intubation
Common pathogens for hospital acquired pneumonia
E. coli
S. aureus (including MRSA) S. pneumoniae Pseudomonas
Ventilator Associated Pneumonia
> 48 hours after tracheal intubation
