Post-operative pneumonia (POP) is a lung infection developing within the first few days or weeks following surgery. This complication is a serious concern, associated with increased illness, extended hospital stays, and higher mortality rates. Anesthesia and surgical pain restrict a patient’s ability to take deep breaths and cough effectively. This shallow breathing leads to the collapse of small air sacs (atelectasis), allowing mucus and secretions to pool and become a breeding ground for bacteria.
Optimizing Lung Health Before Surgery
Preparation for surgery focuses on maximizing lung function to withstand the post-operative period. Patients who smoke should work with their physician to achieve cessation, ideally four to eight weeks prior to the procedure. Stopping smoking improves the function of the cilia, the small hairs lining the airways that sweep out mucus. This action significantly reduces the baseline risk of pulmonary complications.
Patients with chronic lung conditions, such as asthma or Chronic Obstructive Pulmonary Disease (COPD), must ensure these conditions are optimized under a physician’s care. This may involve adjusting maintenance medications or using an inhaler more frequently before the operation. Maintaining excellent nutritional status and hydration is also important, as poor overall health increases vulnerability to infection. Adequate hydration helps keep respiratory secretions thin and easier to clear after surgery.
Active Post-Operative Lung Clearance
Preventing lung complications involves specific, repetitive mechanical techniques to keep the airways open and clear. Deep breathing exercises, often called diaphragmatic breathing, should be performed hourly while the patient is awake to fully expand the lungs. The technique involves a slow, deep inhalation through the nose, holding the breath for three to five seconds, and then a slow, complete exhalation through pursed lips.
An incentive spirometer provides a visual measurement of lung volume, guiding the patient to take maximal inhalations. The patient should exhale normally, then inhale slowly and deeply through the mouthpiece, aiming for a pre-set volume goal. This deep inspiration should be held for two to three seconds to ensure the small air sacs open fully. Patients should aim for approximately ten repetitions every hour to maintain consistent lung expansion.
Effective coughing is necessary to clear mobilized mucus from the airways and requires a specific technique to minimize pain at the incision site. Before coughing, the patient should “splint” the incision by firmly pressing a pillow or folded blanket against the area. This support helps stabilize the muscles, reducing discomfort. A firm, deliberate cough then moves the secretions out of the lungs, and this action should be repeated until the lungs feel clear.
Early and Consistent Mobilization
Physical movement promotes lung health and prevents fluid stagnation, working alongside breathing exercises. Prolonged periods of lying flat contribute to lung collapse (atelectasis) in dependent areas. Changing positions frequently, such as every one to two hours, helps redistribute air and blood flow, encouraging all sections of the lung to expand.
Getting out of bed and sitting upright in a chair is strongly encouraged as soon as the surgical team clears the patient. Sitting up allows the diaphragm to move more freely than when lying down, enabling deeper breaths and greater lung volume. The most effective form of mobilization is standing and walking, which should begin on the day of surgery, if possible.
Walking increases overall circulation and breathing rate, helping to loosen and move respiratory secretions pooling in the lung bases. Studies show that early ambulation can reduce the risk of post-operative pulmonary complications by as much as 23 to 30 percent. This consistent movement is essential for maximizing lung expansion and minimizing infection risk.
Infection Control and Monitoring During Recovery
Controlling the bacterial load is achieved through environmental and personal hygiene measures. Rigorous hand hygiene for both the patient and caregivers is a primary defense against pathogen transmission. Regular and thorough oral care, including brushing the teeth, gums, and tongue multiple times per day, decreases oral bacteria. Fewer oral bacteria means a lower risk of those organisms being inhaled and settling in the lungs.
Maintaining high fluid intake remains important post-operatively to ensure respiratory secretions remain thin and easy to expel. Proper care of the surgical incision prevents systemic infection that can tax the immune system, making the body susceptible to lung infection. The patient and caregivers must also be vigilant in monitoring for the early signs of developing pneumonia.
Warning signs include a persistent fever above 100.4 degrees Fahrenheit, shortness of breath, or new chest pain that worsens with deep breaths. Other indicators are a new or worsening cough, especially if it is productive of discolored, thick mucus. Any combination of these symptoms warrants immediate medical consultation with the surgical team or primary care provider.