Postoperative Atelectasis and Pneumonia after General Thoracic Surgery

Atelectasis and pneumonia are common postoperative complications occurred in patients undergoing general thoracic surgery. Strategies to reduce the risk of postoperative pulmonary complications including these 2 disorders consist of smoking cessation, optimization of underlying chronic obstructive pulmonary disease( COPD), adequate pain control, intensive oral care, and so on. Preoperative treatments for patients with COPD are the same as those for COPD patients being not about to have surgery, which mainly consist of long-acting bronchodilators and pulmonary rehabilitation. Postoperative atelectasis can be treated with airway clearance techniques including postural drainage and coughing, and bronchial suctioning using bronchoscopy or tracheal catheter inserted through cricothyroid ligament as needed. Treatment for postoperative pneumonia starts with microbiologic studies on respiratory samples followed by assessment of existence or non-existence of sepsis, severity of the disease using I-ROAD (immunodeficiency, respiration, orientation, age, dehydration) prognostic guidelines, and risk factors for multidrug-resistance pathogens. Then, adequate selection of antibiotics and escalation or de-escalation principle is required according to the new guidelines recently published by the Japanese Respiratory Society.