Chapter 44

Postoperative Atelectasis
B

A
B
A

Figure 44-1. Alveoli in postoperative atelectasis. A, Total alveolar collapse.

B, Partial alveolar collapse.
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 Anatomic Alterations of the Lungs
 Alveoli of primary lobules (micro-atelectasis
or subsegmental atelectasis)—very common
 Lung segment—fairly common
 Lung lobe—less common
 Entire lung—rare

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 Etiology
Decreased Lung Expansion
 Thoracic and upper abdominal procedures
 Considered high risk for atelectasis

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 Etiology
Decreased Lung Expansion
 Other precipitating factors

 Anesthesia
 Postoperative pain
 Supine position
 Obesity
 Advanced age
 Inadequate tidal volumes during mechanical ventilation
 Malnutrition
 Ascites
 Diaphragmatic apraxia
 The presence of a restrictive lung disorders

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 Etiology
Alveolar Degassing
Atelectasis associated with airway secretions and mucus plugs
 Precipitating factors
 Decreased mucociliary transport
 Excessive secretions
 Inadequate hydration
 Weak or absent cough
 General anesthesia
 Smoking history
 Gastric aspiration
 Certain preexisting conditions (e.g., chronic bronchitis, asthma)

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 Overview of the Cardiopulmonary
Clinical Manifestations Associated
with POSTOPERATIVE
ATELECTASIS
The following clinical manifestations result from
the pathophysiologic mechanisms caused (or
activated) by Atelectasis (see Figure 9-7)—the
major anatomic alterations of the lungs
associated with postoperative atelectasis (see
Figure 44-1)

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 Figure 9-7. Atelectasis clinical scenario.
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 Clinical Data Obtained at the
Patient’s Bedside
Vital signs
 Increased respiratory rate
 Increased heart rate, cardiac output,
blood pressure

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 Clinical Data Obtained at the
Patient’s Bedside
 Cyanosis
 Cough, sputum production, and hemoptysis
 Chest assessment findings
 Increased tactile and vocal fremitus
 Dull percussion note
 Bronchial breath sounds
 Diminished breath sounds
(when mucus plugs present)
 Crackles
 Whispered pectoriloquy

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 Figure 2-11. A short, dull, or flat percussion note is typically produced over areas
of alveolar consolidation.
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 Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lung
unit.
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 Figure 2-19. Whispered voice sounds auscultated over a normal lung
are usually faint and unintelligible.
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 Clinical Data Obtained from
Laboratory Tests and Special
Procedures

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 Pulmonary Function Study:
Expiratory Maneuver Findings

FVC FEVT FEF25%-75% FEF200-1200

 N or  N or  N

PEFR MVV FEF50% FEV1%

N N or  N N or 

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 Pulmonary Function Study:
Lung Volume and Capacity Findings

VT RV FRC TLC
N or    

VC IC ERV RV/TLC%
 
 N

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 Arterial Blood Gases
Small or Localized Postoperative Atelectasis
 Acute alveolar hyperventilation with
hypoxemia

pH PaCO2 HCO3- PaO2

   (Slightly) 

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 Time and Progression of Disease
Disease Onset Alveolar Hyperventilation
100

90 Point at which PaO22

declines enough to
80 stimulate peripheral
oxygen receptors
70
PaO22 or PaCO22

60
PaO2
50

40

30 PaC
O
2
20

10

Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.
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 Arterial Blood Gases
Widespread Postoperative Atelectasis
 Acute ventilatory failure with hypoxemia

pH PaCO2 HCO3- PaO2

   (Slightly) 

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 Time and Progression of Disease
Disease Onset Alveolar Hyperventilation Acute Ventilatory Failure
100

90 Point at which disease

becomes severe and patient
Point at which PaO22
begins to become fatigued
80 declines enough to
stimulate peripheral
70 oxygen receptors

CO2
60 a
P
50

40

30 Pa
O
2
20

10

0
Figure 4-7. PaO2 and PaCO2 trends during acute ventilatory failure.
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 Oxygenation Indices

QS/QT D O2 V O2 C(a-v)O2
  Normal Normal

O2ER SvO2
 

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 Radiologic Findings
Chest radiograph
 Increased density in areas of atelectasis
 Air bronchograms
 Elevation of the hemidiaphragm on the
affected side
 Mediastinal shift toward the affected side

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 General Management of
Postoperative Atelectasis
 Precipitating factors for postoperative atelectasis
should be identified
 High-risk patients should be monitored closely
 Preventive measures should be prescribed for high-
risk patients
 Incentive spirometry
 Chest physical therapy
 Whenever possible, treatment of the underlying cause
of atelectasis should be prescribed immediately

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 General Management of
Postoperative Atelectasis
Respiratory care treatment protocols
 Oxygen therapy protocol
 Bronchopulmonary hygiene therapy protocol
 Hyperinflation therapy protocol
 Mechanical ventilation protocol

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