Pulmonary Complications

Pulmonary Complications

Description, Causes and Risk Factors:

Alternative Names: Lung infections and breathing difficulties.

Pulmonary complications can occur with surgery and play a big role in how patients do after surgery.

Causes and Risk Factors:

    Older age.

  • Pulmonary complications are most common with aortic aneurysm repair, thoracic surgery, abdominal surgery, neurosurgery, vascular surgery, head and neck surgery, surgery lasting for more than 3 hours, emergency surgery, and general anesthesia.

  • The nature of the pulmonary complications can be related to the surgical procedure itself or to the patient. The surgical procedure may be described according to site, duration, and anesthesia from which it may be expected that procedures close to the thorax, prolonged interventions, and general anesthesia are associated with subsequent pulmonary complications.

  • However, patients may also predispose to some risk of complications in the pulmonary structure and functions. Patients with chronic lung diseases tend to have more complications, especially patients with COPD. Age >60 years old, smoking condition, deficient health condition, and heart failure are potential elements of risk for pulmonary complications.

  • Typical pulmonary complications are local infections like pneumonia, disordered gas exchange with respiratory failure, bronchospasm, atelectasis, and/or exacerbations of previously existing pulmonary conditions.

Identifying patients before surgery who are likely to develop these complications would help doctors to advise patients about these risks. Good information about ways to reduce these complications would also be useful.


The more common pulmonary complications are:

    Pulmonary Embolism: Usually presents with shortness of breath, but sometimes there may be no symptoms. With larger emboli there is also chest pain, wheezing and lung collapse.

  • Lung Infections: The incidence of postoperative pulmonary infections is about 20%. Predisposing causes include prolonged operations and prolonged antibiotic treatment leading to infection with antibiotic resistant strains of bacteria, especially in patients with reduced resistance.

  • Lung Collapse: Areas of lung tissue are prone to collapse, because of the anaesthetic and surgical problems mentioned above.

  • Pulmonary edema: Excessive fluid in the lung due to fluid overload, or heart dysfunction or as a complication of airway obstruction.

  • Aspiration pneumonia: Pulmonary inflammation caused by aspiration of stomach or other secretions (blood, vomit, food) into the lung. The lung inflammation is usually more severe if the stomach contents are acidic; thus patients are often asked to ingest antacid drugs before an operation to make the gastric secretions more alkaline.

  • Exacerbation of Asthma or Bronchitis: It is not uncommon for asthmatic or chronic bronchitic patients to suffer an attack following the operation. A number of factors can trigger off this - infections, airway irritation by endotracheal tube, allergic reactions, lung emboli. These patients should therefore be improved as much as possible before being subjected to a non urgent operation.


The physical examination must be directed to find anomalies of the pulmonary area as well as trachea at the neck.

The only laboratory test result that predicted pulmonary complications is low serum albumin level (less than 3.5 g/dL). Doctors should not routinely use pre-surgery tests of lung function or chest radiography to predict the risk for pulmonary complications.

Other Tests:

    Pulmonary function tests (spirometry).

  • Arterial blood gas analysis.

  • Chest X-rays.


Treatment Options Include:

    Deep breathing exercises reduce the risk for pulmonary complications.

  • Selective use of a nasogastric tube for nausea, vomiting, or abdominal distention only reduces pulmonary complications after abdominal surgery.

  • In addition, doctors should not use right-heart catheterization or artificial nutrition to reduce the chances of pulmonary complications.

After consideration of risk, patients would be able to receive instructions like: Smoking cessation, COPD optimization of therapy, and some recommendations after surgery: lung expansion maneuvers, appropriate analgesia and prophylaxis of deep venous thrombosis.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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