Atelectasis is the most common post operative pulmonary complication by which tissue oxygenation may be compromised in the elderly. It affects a quarter of all patients recovering from abdominal or thoracic surgeries. . Atelectesis, a failure of part of the lungs to expand, usually develops during the first or second postoperative day. Contributing factors in the aged are shallow breathing, obstruction of the airway with secretions, pain (which results in smaller tidal volumes), immobility, a transient decrease in surfactant production, a weakened cough reflex and decreased ciliary movement. Atelectasis as a result of any of these factors can lead to a mismatching of ventilation and perfusion and thereby, to arterial hypoxemia.
Areas of alveolar collapse or atelectasis are prone to infection. if an area of the lung remains atelectatic for greater than 72 hours, pneumonia is likely to develop. In the elderly, taking agressive measures to prevent atelectasis is preferable to treating pneumonia that may result from it. Frequent incentive spirometry maneuvers with an inspiratory hold, turning every two hourly, early ambulation and mobilization as soon as the vitals are stable, are important therapeutic interventions. Pain management without the use of sedatives, that depresses respirations, can also prevent alveolar compromise.
If atelectasis does develop, strategies such as administration of chest physiotherapy for mobilizing secretion, hyperinflation therapies such as IPPB ( Intermittent positive pressure breathing) or CPAP ( Continuous positive airway pressure) and moderate suctioning may help remove secretion, reverse atelectasis and aid in the reexpansion of lungs.