Atelectasis: risk and prevention

Atelectasis is the collapse of alveoli that are no longer being inflated — because breathing has become shallow, because secretions have blocked the airway that feeds them, or because a high concentration of oxygen has washed out the nitrogen that held them open — so the patient at risk is anyone whose breathing is shallow or whose cough is suppressed: the patient recovering from anaesthesia and from surgery, above all through a thoracic or upper-abdominal incision, the patient who is in pain, sedated or receiving opioids, the patient who is immobile or kept supine, and the patient who smokes, is obese, is older, has chronic lung disease or cannot clear thick secretions — and the nurse prevents it rather than awaits it by having the patient turn, sit up and walk from the earliest hours, breathe deeply and cough at regular intervals with the incision splinted, use the incentive spirometer as a slow sustained inspiration held at the top rather than a hard blow out, and receive enough analgesia to breathe deeply rather than so little that they guard or so much that they hypoventilate, keeps secretions loose with hydration, humidification and chest physiotherapy where it is prescribed, and holds the oxygen concentration at what the patient needs, while recognising the atelectasis that has developed anyway in its insidious early form — increasing breathlessness, a cough, a rising respiratory rate and pulse, a low-grade fever in the first days after surgery, diminished breath sounds or crackles over the affected area and a falling saturation — as a lung to be re-expanded by the same measures given more often and more deliberately, not as a wound infection, fluid overload or a reason to rest the patient more, and escalates when they fail because collapsed lung that stays collapsed fills with secretions and becomes pneumonia.