The incidence of atelectasis following thoracic and upper abdominal surgery is high and can be related to several etiologic factors. These include "splinting," suppression of the sigh reflex, absence of a vigorous cough, accumulation of fluid in the intrapleural space, absorption atelectasis secondary to the inhalation of oxygen-enriched breathing mixtures, and atelectasis caused by endotracheal suctioning.
A careful consideration of the pathophysiology of atelectasis yields valuable lessons regarding the rational means to be used for its reversal. A maximal inspiratory effort is the most efficacious maneuver available for preventing and reversing alveolar collapse. A forced expiratory effort is, at best, a painful and futile exercise; at worst, a maximal expiratory maneuver may produce the very lesion it is supposed to cure. Devices employed in an effort to reduce the incidence of atelectasis must be chosen accordingly.
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