Respiratory Complications

Respiratory complications occur in many surgical patients and range from atelectasis and pneumonia to pneumothorax or pulmonary embolism. Atelectasis

Atelectasis, the collapse of pulmonary alveoli, is very common. Contributing factors include inadequate clearance of secretions following general anesthesia, decreased intraalveolar pressure, and postoperative pain, which results in hypoventilation. While atelectasis can occur following any procedure, it frequently occurs following upper abdominal and thoracic surgery. The presentation varies from an isolated fever to tachypnea, dyspnea, and tachycardia.

Evaluation includes a chest radiograph, pulse oximetry, and a complete blood count (CBC). Chest radiographs may be normal or show platelike linear densities, triangular-shaped densities, or lobar consolidation. Mild hypoxemia from ventilation-perfusion mismatch is common, but hypercarbia is uncommon. Patients with mid atelectasis and no evidence of hypoxemia may be managed as outpatients with pain control and increased deep breathing. Admission is indicated for aggressive pulmonary toilet and supplement oxygenation in debilitated patients, patients with underlying lung disease, patients with hypoxemia, or those in whom the diagnosis is in question.

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