Atelectasis After Surgery: Prevention and Treatment

Prevention and Treatment of Atelectasis Before and After Surgery

Bracing while coughing, how to cough after surgery
Bracing the Stomach While Coughing Prevents Pain.

What is Atelectasis?

Atelectasis is a lung condition where areas of the lung collapse.  This collapse won’t allow the alveoli (air sacs) in this area of the lung to fill with oxygen, so this area of the lung no longer functions.  The amount of lung affected can vary widely between individuals, a small area of one lung may be affected or large areas of both lungs may be involved. 

Risk Factors For Atelectasis:

Age: Patients who are three years old or younger are more likely to develop atelectasis, even more than elderly adults who have a slightly elevated risk.

Lung Conditions: Lung conditions that are present before surgery, such as pneumonia or lung cancer, can make it more likely that atelectasis will occur.  

Surgery: Having surgery is a major risk factor for having atelectasis.  There are two primary reasons for this: the being on a ventilator during surgery and the inability to cough to clear the lungs while under anesthesia.  The ability to take a deep breath and cough helps prevent atelectasis.  

Pain When Breathing:  If an injury, lung condition or surgery make it painful to breathe is present, the patient is more likely to experience atelectasis.  People who feel pain when they breathe are not likely to take deep breaths and they tend to stifle coughs.  This can lead to poor inflation of the lungs, which can lead to atelectasis.

Ventilator:  Being on a ventilator is a major risk factor for atelectasis.  For these patients, coughing is not possible and the suctioning provided by nurses is not as effective as coughing for the prevention of atelectasis.

Smokers:  Smoking increases the risk of atelectasis after surgery.  Quitting smoking prior to surgery dramatically reduces the risk of atelectasis and many other complications.

Obesity: A healthy body weight reduces the risk of atelectasis.

Individuals who have multiple risk factors are at a greater risk for developing atelectasis.

  An individual who is obese, smokes a pack of cigarettes a day and has lung disease has a higher risk of developing atelectasis than the average surgery patient.  

When Atelectasis Is Serious

Atelectasis can be a minor complication, but it can become a very serious complication when the patient has other serious issues after surgery.  An individual who is kept on a ventilator after surgery is likely already very ill and atelectasis can be an unwanted complication as it can lead to more serious lung problems than those that already exist.  For patients who already have compromised lung function, such as an individual who has lung cancer, or who only has one lung, the condition can mean too little oxygen is reaching the body.

Atelectasis isn’t always serious, a very small area of atelectasis will likely not be an issue for most individuals, but when large areas of one or both lungs are affected, the condition can be life-threatening and requires immediate and aggressive treatment.  Atelectasis can also be complicated by the presence of pneumonia.

Preventing Atelectasis

One of the best ways to prevent atelectasis is to control pain so that it is not painful to breathe.  This may mean that pain medication is necessary to lessen the pain that is present so that deep breathing is more natural.  Coughing regularly, and certainly when the urge strikes, is also important.  The action of both coughing and deep breathing is important to fully expanding the lungs, which prevents atelectasis.

Some patients may be given cough and deep breathing exercises, which is exactly what it sounds like.  The patient may be instructed to take ten slow and deep breaths, followed by a forceful cough.  In the early days after surgery these type of exercises are important for preventing atelectasis and pneumonia.


What is Atelectasis.  Heart, Lung and Blood Institute. Accessed July, 2015.

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