Atelectasis and
pneumonia are common postoperative complications occurred in patients undergoing general thoracic surgery. Strategies to reduce the risk of postoperative pulmonary complications including these 2 disorders consist of smoking cessation, optimization of underlying
chronic obstructive pulmonary disease(
COPD), adequate
pain control, intensive oral care, and so on. Preoperative treatments for patients with
COPD are the same as those for
COPD patients being not about to have surgery, which mainly consist of long-acting
bronchodilators and pulmonary rehabilitation. Postoperative
atelectasis can be treated with airway clearance techniques including
postural drainage and coughing, and bronchial suctioning using bronchoscopy or tracheal
catheter inserted through cricothyroid ligament as needed. Treatment for postoperative
pneumonia starts with microbiologic studies on respiratory samples followed by assessment of existence or non-existence of
sepsis, severity of the disease using I-ROAD (immunodeficiency, respiration, orientation, age,
dehydration) prognostic guidelines, and risk factors for multidrug-resistance pathogens. Then, adequate selection of
antibiotics and escalation or de-escalation principle is required according to the new guidelines recently published by the Japanese Respiratory Society.