Pulmonary atelectasis is a prevalent issue in surgical patients, significantly impacting gas exchange and respiratory mechanics both during and after surgical procedures. In severe cases, lung collapse can lead to postoperative respiratory insufficiency, pneumonia, and worsened patient outcomes. Therefore, a detailed risk assessment is crucial for clinicians to optimize anesthetic techniques, implement appropriate monitoring strategies, and adapt the perioperative plan, ultimately ensuring patient safety. Recent advancements in bedside diagnostics, such as lung ultrasound and electrical impedance tomography, alongside monitoring tools like esophageal manometry, have greatly improved diagnosis and management.
Therapeutic interventions for atelectasis are diverse, focusing on promoting lung recruitment. While strategies employed during general anesthesia have proven effective in enhancing intraoperative oxygenation and respiratory compliance, their impact on postoperative pulmonary outcomes remains less consistent. The postoperative period warrants specific attention to maximize the benefits of lung expansion. Interventions like noninvasive positive pressure ventilation can be particularly beneficial for high-risk patients, such as those with obesity, or those exhibiting clinical signs of lung collapse, like postoperative hypoxemia following abdominal and cardiothoracic surgeries.
Looking ahead, preoperative interventions present new opportunities to minimize perioperative lung collapse and prevent subsequent pulmonary complications. A thorough understanding of the pathophysiological mechanisms of atelectasis and its consequences in both healthy and diseased lungs is fundamental. This knowledge should guide current clinical practice and enable clinicians to effectively stratify risk and tailor the intensity of interventions to individual patient conditions, ensuring a robust preparatory care plan for patients diagnosed with atelectasis.
