Postoperative pneumonia (POP) is an infection of the lung tissue that develops after a surgical procedure. This complication is a serious concern for surgical patients, often leading to longer hospital stays and increased recovery time. Understanding the factors that make the lungs susceptible and implementing targeted preventative measures can significantly reduce this risk. This article provides actionable steps for patients to protect their respiratory health before and after an operation.
Why Lungs Are Vulnerable After Surgery
The process of undergoing surgery introduces several physiological changes that compromise the lungs’ natural defenses. General anesthesia temporarily suppresses the body’s protective reflexes, including the ability to cough effectively and take regular, deep breaths. This shallow breathing pattern, known as atelectasis, causes small air sacs (alveoli) in the lungs to collapse.
Collapsed alveoli prevent the normal exchange of oxygen and carbon dioxide and allow mucus secretions to pool in the lower parts of the lungs. This accumulation creates an ideal environment for bacteria to multiply. Pain at the surgical site further exacerbates this issue, as patients instinctively take shallow breaths to avoid discomfort.
Prolonged immobility in a supine or semi-reclined position also contributes to this cycle of shallow breathing and poor secretion clearance. Without movement, the lungs cannot fully inflate, which allows the stagnant fluid to become a breeding ground for infection. Preventing this cascade of events is the primary goal of postoperative respiratory care.
Pre-Surgical Risk Reduction
Patients can take powerful steps before their procedure to optimize their lung health, a process known as prehabilitation. One of the most effective actions is complete smoking cessation, which should be initiated well in advance of the operation. Quitting tobacco for at least four to eight weeks before surgery is necessary to achieve a significant reduction in respiratory complications.
The longer the period of abstinence, the greater the benefit. Patients who stop smoking 10 weeks or more before their procedure may achieve complication rates comparable to those who have never smoked, as this allows the respiratory tract’s lining to begin healing. Patients should also work closely with their physician to ensure chronic respiratory conditions like asthma or Chronic Obstructive Pulmonary Disease (COPD) are optimally managed.
Ensuring adequate nutritional status before surgery is also important for supporting immune function and tissue repair. Poor nutrition is associated with a higher risk of complications, including infection. By addressing these modifiable risk factors, patients establish a healthier baseline for recovery.
Essential Postoperative Respiratory Techniques
The most direct way to combat POP risk is through active, consistent respiratory exercises that re-expand the lungs and clear secretions. Deep breathing and coughing are foundational techniques that must be performed regularly, even when the patient is tired or in discomfort. A crucial strategy is the splinting technique, which involves holding a pillow firmly against the surgical incision while taking a deep breath or coughing. This provides counter-pressure, significantly reducing pain and allowing for a more forceful, productive cough that clears mucus from the airways.
Another powerful tool provided in the hospital is the incentive spirometer, a small handheld device used to encourage slow, deep breaths. To use it correctly, the patient should sit upright, place the mouthpiece in their mouth, and inhale slowly and deeply, attempting to raise the indicator to the target volume set by their care team. The inhalation should be held for at least three to five seconds before exhaling slowly.
The incentive spirometer should be used approximately 10 times every hour while the patient is awake to prevent the collapse of the small air sacs. It is important to emphasize that the device requires an inhalation to work, not an exhalation, as the goal is to maximize lung volume. Following the spirometry exercises, a deep breath and a splinted cough help move any loosened secretions out of the lungs.
Early and frequent ambulation, or walking, is another highly effective measure that mechanically aids lung function. Even short walks around the room or hallway help mobilize secretions and naturally encourage deeper breathing than when lying down. Physical movement helps to reverse the effects of immobility and is a simple, yet powerful, component of a comprehensive pulmonary hygiene regimen.
Supporting Recovery and Recognizing Complications
Effective pain management is closely linked to respiratory health, as uncontrolled pain is a major barrier to deep breathing and coughing exercises. Patients must communicate their pain level honestly with their care team so that appropriate medication can be administered. Controlling pain ensures the patient is physically able to perform the necessary lung exercises without undue discomfort.
Maintaining adequate hydration is also important because it helps keep mucus thin, making it easier to cough up and clear from the lungs. Drinking plenty of fluids, as permitted by the surgical team, directly supports the body’s natural secretion clearance mechanisms and prevents accumulation.
Patients and caregivers must remain vigilant for signs of developing pneumonia and seek medical attention immediately if symptoms appear. Warning signs include:
- A fever above 100.4°F (38°C).
- A persistent, productive cough.
- Shortness of breath.
- Chest pain or chills.
- A cough that produces colored (yellow, green, or bloody) sputum.
Early recognition of these signs allows for prompt treatment, which is essential to prevent the infection from becoming severe.