Atelectasis does NOT explain post operative fevers

[europeman]

I've been saying this for years. It's been discussed in the medical student forumns. Now this nice review came out in THIS WEEKS CHEST. Attached below is the abstract.

I think it's a great example of how some dogmatic thing in surgery is taught to us despite no real evidence for it. In fact, most the evidence is against.

That said, clinically for me it doesn't change anything because recruiting alveoli is good anyway. Atelectasis clearly can be a the cause of the a pneumonia to start, which of course would start a fever. And atelectasis decreases your v/q ratio which obviously isn't good.

However, to blindly attribute your post op patients fever to atelectasis I think is naive




Atelectasis as a Cause of Postoperative Fever

Where Is the Clinical Evidence?


Abstract

Background: Atelectasis is considered to be the most common cause of early postoperative fever (EPF) but the existing evidence is contradictory. We sought to determine if atelectasis is associated with EPF by analyzing the relevant published evidence.

Methods: We performed a systematic search in PubMed and Scopus databases to identify studies examining the association between atelectasis and EPF.

Results: A total of eight studies, including 998 cardiac, abdominal, and maxillofacial surgery patients, were eligible for analysis. Only two studies specifically examined our question, and six additional articles reported sufficient data to be included. Only one study reported a significant association between postoperative atelectasis and fever, whereas the remaining studies indicated no such association. The performance of EPF as a diagnostic test for atelectasis was also assessed, and EPF performed poorly (pooled diagnostic OR, 1.40; 95% CI, 0.92-2.12). The significant heterogeneity among the studies precluded a formal metaanalysis.

Conclusion: The available evidence regarding the association of atelectasis and fever is scarce. We found no clinical evidence supporting the concept that atelectasis is associated with EPF. More so, there is no clear evidence that atelectasis causes fever at all. Large studies are needed to precisely evaluate the contribution of atelectasis in EPF.


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[SLUser11]

I've been saying this for years. It's been discussed in the medical student forumns. Now this nice review came out in THIS WEEKS CHEST. Attached below is the abstract.

I think it's a great example of how some dogmatic thing in surgery is taught to us despite no real evidence for it. In fact, most the evidence is against.

That said, clinically for me it doesn't change anything because recruiting alveoli is good anyway. Atelectasis clearly can be a the cause of the a pneumonia to start, which of course would start a fever. And atelectasis decreases your v/q ratio which obviously isn't good.

However, to blindly attribute your post op patients fever to atelectasis I think is naive.

We talked about this in a very recent thread, and discussed the literature, as well as the real cause of atelectasis. I guess you missed that one.

I like that you are hungry for evidence, but I don't know if your approach is the best. It's like you are riding in on your evidence high-horse and trying to rock our worlds with all these facts we're not ready to hear. If you really want to educate the SDN community, and not just look like a condescending know-it-all, I would slow your roll a little bit.

 

[ESU_MD]

A classic example that anyone with enough knowledge of statistics and elaborate vocabulary can come up with a paper/book report that supports a theory.

I am sure this was some project conjured up and worked on by some academic attending who was in protected "off-service" time and now they got a paper in a prestigious medical journal to talk about during rounds for years to come.

how will this addition to the literature change the working surgeons practice?

 

[maxheadroom]

Guess I'll get rid of that stupid incentive spirometer. Finally.

 

[filter07]

review of 8 papers. wow, that is strong work.

 

[europeman]

We talked about this in a very recent thread, and discussed the literature, as well as the real cause of atelectasis. I guess you missed that one.

I like that you are hungry for evidence, but I don't know if your approach is the best. It's like you are riding in on your evidence high-horse and trying to rock our worlds with all these facts we're not ready to hear. If you really want to educate the SDN community, and not just look like a condescending know-it-all, I would slow your roll a little bit.

SLUser11, i think you are mis-interpreting my attitute in that post. I'm just excited 'cuz I thought that article is cool/interesting. I'm certainly not intentionally acting like a know-it-all,

And Maxheadroom, I know your comment is sarcastic, but, the point of the article I think for me is that some things which are taught as dogmatic aren't really based in anything legit... nonetheless, as I allude to, it still is important to do is pulmonary toilet.

 

[SLUser11]

SLUser11, i think you are mis-interpreting my attitute in that post. I'm just excited 'cuz I thought that article is cool/interesting. I'm certainly not intentionally acting like a know-it-all,

And Maxheadroom, I know your comment is sarcastic, but, the point of the article I think for me is that some things which are taught as dogmatic aren't really based in anything legit... nonetheless, as I allude to, it still is important to do is pulmonary toilet.

Fair enough.

I get excited about articles, too. As a matter of fact, when the NICE-Sugar trial came out, I found a way to incorporate it into almost every conversation.

I don't think you are actually a "know it all." In fact, I think that you and I are similar when it comes to our approach to surgical convention. I'm only bringing these points up because I'm prone to the same behavior.

 

[europeman]

i misspoke. I meant to say atelectasis can predispose you to pneumonia because it can act as a harbenger of infection for bugs to thrive.

 

[45408]

Like I said before, I can't help but notice that most/all of the articles that fail to find any association between atelectasis and fever are published by people who never do surgery (or at least in journals in principally non-surgical fields).

 

[myhandsarecold]

heh, atelectasis causing fever doesn't make sense. it's probably just upregulated prostaglandins from being cut open.

 

[SLUser11]

heh, atelectasis causing fever doesn't make sense. it's probably just upregulated prostaglandins from being cut open.

Well, it makes sense from a physiologic perspective. In response to atelectasis, alveolar macrophages secrete IL-1, which in turn causes fever.

However, this has not been shown to be true.

A famous quote from Thomas Henry Huxley says it best: "The great tragedy of science: the slaying of a beautiful hypothesis by an ugly fact."

 

[cpants]

Honestly, everyone pretty much knows atelectasis doesn't cause fever. We just kindof wink and nod at the diagnosis in situations where we don't think the patient is infected and don't want to be obligated to start antibiotics etc. When we say atelectasis we really mean idiopathic postop fever.