The Prevention of Postoperative Pulmonary Atelectasis

Palmer, K.N.V.; Sellick, B.A.

doi:10.1016/s0140-6736(53)90781-8

Cited by 65 publications

(11 citation statements)

References 16 publications

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“…Thirty-six years later, "continuous" posturing was still advocated [11] often starting with 10 min three times a day and gradually increasing to at least three periods of 2 h during the day and for the greater part of the night. The use of postural drainage with vibration and clapping percussion, in combination with a bronchodilator, was documented in 1953 as more effective than breathing exercises alone in the prevention of postoperative pulmonary atelectasis [12]. Postural drainage with chest clapping remained the "gold standard" of chest physiotherapy for many years, until new techniques emerged in the 1960s [13,14].…”

Section: Historical Backgroundmentioning

confidence: 99%

Physiotherapy for airway clearance in adults

1999

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Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults.Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet1, Flutter1, positive expiratory pressure mask, highfrequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders.The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient.

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Section: Historical Backgroundmentioning

confidence: 99%

Physiotherapy for airway clearance in adults

1999

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“…TM Physiotherapy with and without bronchodilator therapy has been demonstrated to be effective in reducing the incidence of postoperative atelectasis.2Z. [46][47][48] Preoperative pulmonary assessment and management may be subdivided into three levels of care. Level one care is that provided to all patients who have one or more of the major risk factors enumerated in Table I.…”

Section: Managementmentioning

confidence: 99%

Pulmonary atelectasis after anaesthesia: Pathophysiology and management

Rigg¹

1981

Canad. Anaesth. Soc. J.

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The pathophysiological basis of pulmonary atelectasis is reviewed and risk factors that enhance lung collapse are discussed. Management strategies to reduce or eliminate risk factors and to prevent collapse are discussed and the rational bases of these strategies are identified.Instability of lung alveoli is a consequence of surface tension and regional differences in alveolar size. The inherent tendency of alveoli to collapse is enhanced by the following risk factors; low lung volume, high closing volume, oxygen therapy, a rapid shallow ventilatory pattern, chronic lung disease, smoking, obesity, postoperative pain following abdominal or thoracic surgery, narcotic induced ventilatory depression, and neurological, neuromuscular, muscular and musculoskeletal diseases associated with mechanical impairment of respiratory function. The primary goal of perioperative respiratory management is prevention of atelectasis. Appropriate management strategies include physiotherapy and delay of elective surgery if substantial improvement in respiratory status can be achieved by specific treatments such as antibiotics, bronchodilators, steroids, and reduction of tobacco use and caloric intake. In selected cases, elective postoperative controlled ventilation may be indicated.KEY WORDS: ANAESTHESIA, COMPLICATIONS, atelectasis; LUNG, atelectasis.LUNG COLLAPSE and infection leading to acute respiratory failure is a major cause of post surgical morbidity and mortality. 1'2 Small area, of "silent" pulmonary atelectasis develop insidiously and frequently precede overt clinical evidence of lung collapse and other associated postanaesthetic pulmonary problems) It is the purpose of this paper to review the pathophysiology and pathogenesis of pulmonary atelectasis and the physiological basis for pulmonary management in the postoperative period. PATHOPHYSIOLOGY AND PATHOGENESIS OF ATELECTASISThe inflated lung is inherently unstable; in other words, it tends to collapse spontaneously, an observation that may be confirmed directly in the apnoeic lung at thoracotomy. The tendency to collapse results from two fundamental physical characteristics of the intact lung and is The first physical characteristic is the presence of surface tension at the gas liquid interface of the alveoli. In an isolated alveolus, assumed to be spherical in shape,* the pressure (P) tending to collapse that alveolus is given by the following expression of Laplace's Law-2T P= r where T = surface tension and r = radius of curvature of the alveolus: This relationship indicates that the pressure tending to collapse the alveolus is directly proportional to the surface tension at the alveolar lining and inversely proportional to the radius (or the size) of the alveolus. *It is recognised that the spherical balloon model is a considerable simplification of alveolar shape. A more precise equation to compute the collapsing pressure within non-spherical objects is given by P = T~/r~ + T2/r2, where r~ and r z are the principal radii of curvature and T~ and T2 correspondi...

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“…3,4 Although the mechanisms of susceptibility to infection and its prevention with adequate ventilation of atelectatic lung segments remain unclear, it is assumed that changes in the lung alveolar microenvironment may influence the occurrence of pulmonary infections. 5 The sterility of lung alveoli is maintained primarily by the ability of alveolar macrophages (AMs) to overcome the microorganisms escaping mechanical clearance.6 9 We evalu¬ ated the role of a possible AM dysfunction in the precipita¬ tion of infection in the atelectatic lung.…”

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confidence: 99%