Abstract
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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