Atelectasis in postoperative bariatric surgery: how many understand them?

Dear Editor,

This topic¹ is very important for the multidisciplinary team that working with this population of patients in order to know the possible factors associated with the risk of pulmonary complications and determine strategies to minimize these complications. However, we consider that after deep analysis, some key practical issues need proper discussion.

First, although the retrospective design of the study in question is subject to temporal biases, the assessments performed by different team members may also result in some described results, especially for the very short outcome analysis. In this line, we consider appropriate that it could be interesting to evaluate patients only with previous pulmonary alterations and specific pulmonary test evaluations, so it would be possible to determine the objective and definitions of "higher risk" to develop postoperatory atelectasis. Guimarães et al. assess the impact of immediate postextubation use of Boussignac Continuous Positive Airway Pressure (CPAP) on arterial oxygenation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. The authors demonstrated application of Boussignac CPAP for 2 h after extubation improved oxygenation but did not improve forced expiratory volume at 1 s and forced vital capacity.²

Secondly, the authors demonstrate that gender is a risk factor associated with atelectasis in the post-operative period, however, 82.8% of subjects included in the study were female, and this outcome would not be expected? This is not clear answer that has implications for preventive postoperative complications protocols. Baltieri et al. determined what moment of application of positive pressure brings better benefits on lung function, incidence of atelectasis and diaphragmatic excursion, in the preoperative, intraoperative or immediate postoperative period and demonstrated the optimal time of application of positive pressure is in the immediate postoperative period, immediately after extubation, because it reduces the incidence of atelectasis. The predominant gender in the study were female.³

Thirdly, an important point to note in this study was the physical therapy twice a day, which started on the first day after surgery. We previously conducted a randomized clinical trial to evaluate the effect of physical therapy care in the immediate postoperative period in patients undergoing abdominal surgery.⁴ We showed that physical therapy performed in the immediate postoperative period reduced the loss of lung function, loss of respiratory muscle strength and length of stay in the recovery room.

We believe that, as well as the interesting results of this study, further research to assess complications in the postoperative period and possible associated risk factors should be encouraged.

References

• ¹
  Baltieri L, Peixoto-Souza FS, Rasera-Junior I, et al. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery. Rev Bras Anestesiol. 2016;66:577-82.
• ²
  Guimarães J, Pinho D, Nunes CS, et al. Effect of Boussignac continuous positive airway pressure ventilation on PaO₂ and PaO₂/FiO₂ ratio immediately after extubation in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial. J Clin Anesth. 2016;34:562-70.
• ³
  Baltieri L, Santos LA, Rasera I, et al. Use of positive pressure in the bariatric surgery and effects on pulmonary function and prevalence of atelectasis: randomized and blinded clinical trial. Arq Bras Cir Dig. 2014;27(Suppl. 1):26-30.
• ⁴
  Junior LAF, Carvalho AT, Ferreira TS, et al. Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal. J Bras Pneumol. 2009;35:455-9.

Publication Dates

• Publication in this collection
  Jan-Feb 2018