Definitions
Pulmonary collapse or atelectasis results from alveolar hypoventilation such that the alveolar walls collapse and become de-aerated. Pneumonia is an infection with consolidation of the pulmonary parenchyma.
Key Points
- Thoracic and upper abdominal incisions are at high risk of postoperative pulmonary collapse ± infection.
- Aggressive prophylaxis is key to prevention of complications.
- Postoperative pneumonia is often due to mixed organisms.
- Postoperative pulmonary complications prolong hospital stay by 1–2 weeks.
Aetiology/Pathophysiology
Postoperatively patients frequently develop atelectasis, which may develop into a pneumonia.
Pulmonary Collapse
- Proximal bronchial obstruction.
- Trapped alveolar air absorbed.
- Common in smokers.
- Common with COPD, asthma or sleep apnoea.
Pneumonia
- Infection with micro-organisms.
- Bacterial: Streptococcus pneumoniae, Staphylococcus, Haemophilus influenzae.
- Viral: influenza, CMV.
- Fungal: Candida, Aspergillus.
- Protozoal: Pneumocystis, Toxoplasma.
Pulmonary Embolism
See venous thromboembolism (see Chapter 73).
Predisposing Factors
- Secretional airway obstruction.
- Bronchorrhoea post surgery.
- Mucus plugs block bronchi.
- Impaired ciliary action.
- Postoperative pain prevents effective coughing
- Organic airway obstruction.
- Bronchial neoplasm.
Patients Prone to Severe Pneumonia
- The elderly.
- Alcoholics.
- Chronic lung and heart disease.
- Debilitated patients.
- Diabetes.
- Post-CVA.
- Immunodeficiency states.
- Post-splenectomy.
- Atelectasis post surgery.
Clinical Features
Pulmonary Collapse
- Pyrexia.
- Tachypnoea.
- Diminished air entry.
- Bronchial breathing.
Pneumonia
- Respiratory distress.
- Painful dyspnoea.
- Tachypnoea.
- Productive cough ± haemoptysis.
- Hypoxia – confusion.
- Diminished air entry.
- Consolidation.
- Pleural rub.
- Cyanosis.
Investigations
- Chest X-ray: consolidation, pleural effusion, interstitial infiltrates, air–fluid cysts.
- Sputum culture: essential for correct antibiotic treatment.
- Blood gas analysis: diagnosis of respiratory failure.
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