Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

Abstract

The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient’s safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.

Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study

“…An association between general anaesthesia and atelectasis is well established. The causal mechanisms of atelectasis due to general anaesthesia, methods of perioperative prevention and treatment options have been previously described 10 , 11 . In an observational study previously published by Zieleskiewicz and colleagues, early postoperative atelectasis diagnosed in the PACU was associated with a longer duration of hospital stay, an increased need for postoperative mechanical ventilation, and an increase in postoperative mortality 7 .…”

“…Atelectasis was diagnosed when a finding of lung collapse was made on chest X-ray, chest CT and/or lung ultrasound 10 , 11 . Pneumonia was diagnosed when the following criteria were met: radiological signs (two successive chest X-rays showing new or progressive lung infiltrates), at least one of the following signs (temperature more than 38.3°C without any other cause, leukocytes more than 4000 mm 3 or more than 12 000 mm 3 ) and at least two of the following signs (purulent sputum, cough, or dyspnoea, declining oxygenation or increased oxygen requirement, or need for respiratory assistance) 12 .…”

Robotic approach for pediatric pulmonary resection: preliminary investigation and comparative study with thoracoscopic approach

“…Data on general information (age, sex, and weight), surgical features (total operative time, pure operative time, and conversion), body temperature (>38 ℃), and postoperative complications (pneumothorax, hemothorax, air leak, atelectasis, or residual lesions) of the two groups were collected and compared (Table 2). The postoperative complications are listed in Table 3 (17)(18)(19)(20)(21)(22)(23). The total operative time refers to the time from the opening of the incision to its closure, which includes pure operative time, docking time, undocking time, and instrument-replacement time in the RPR group and pure operative time and instrument-replacement time in the TPR group.…”

Proteomics of lung tissue reveals differences in inflammation and alveolar-capillary barrier response between atelectasis and aerated regions

“…Pulmonary atelectasis affects many surgical patients during perioperative period and critically ill patients and has been frequently cited as a contributing factor for lung injury and acute respiratory distress syndrome (ARDS) 1 – 3 . While the physiology and clinical relevance of atelectasis are well established, there is surprisingly scant data and controversial information on its biological effects.…”