Prevention and treatment of pulmonary complication (Massive atelectasis)

This prospective study was designed to survey the incidence, prevention and treatment of massive atelectasis in 1222 consecutive patients following upper abdominal surgery. The massive atelectasis was assessed by radiologically.Following perioperative examinations were undertaken: 1. Pulmonary function test except emergency case. 2. Preoperative upright and supine chest x-ray. Supine chest x-ray was taken before extubation and at 24, 48, 72 and every day or every two days thereafter unless required frequently. 3. Blood gases were analysed preoperative, operative and postoperative period when indicated. 4. Frequent and close auscultation of the chest.Preventive measures were as follows: 1. Preoperative deep breathing exercise by tissue paper breathing method and coughing exercise. 2. Coughing and selective bronchial suctioning using a curved tipped catheter with a guide mark during operation and before extubation. 3. Encouraging deep breathing by tissue paper breathing method and coughing postoperatively. We did not use IPPB nor incentive spirometer. The chest x-ray was taken and blood gases were analysed when the breath sound did not improved by above mentioned measures (2 and 3) or when indicated.Following treatments were performed. 1. Vigorous tracheal compression. 2. Transtracheal injection. 3. Selective bronchial suctioning following endotracheal intubation, when the breath sound did not improved by 1 and 2 procedures or atelectasis was assessed by the chest x-ray.Results: No atelectasis was found at the end of operation. Five atelectasis occurred in 5 out of 1222 patients. Two cases of atelectasis occurred among 81 cases of emergency. One case was treated by vigorous external tracheal compression and another one case was treated by transtracheal injection. The rest of three cases was treated by selective bronchial suctioning following endotracheal intubation. We did not use bronchofiber scope in this study.We found that important preventive measures were frequent and close auscultation of the chest, coughing and selective bronchial suctioning during operation and bofore extubation. In the postoperative period, encouraging deep breathing and coughing were also important measures of prevention. The important procedures of treatment were external tracheal compression, transtracheal injection and selective bronchial suctioning following intubation. The proper techniques of selective bronchial suctioning was described.