Postoperative chest infections

Definition:

Infection of the respiratory tract includes a wide range of conditions:

• Bronchitis
• Pneumonia
• Lung abscess
• Empyema

An element of alveolar under-expansion after operation is common – this can cause mild pyrexia

Organisms:

• Pneumococcus
• Haemophilus influenzae

Gram –ve organisms can also be found in postoperative chest infections

Symptoms:

• Fever
• Cough
• Breathlessness
• Confusion (from hypoxia)

Signs:

• Cyanosis
• Green sputum
• Consolidation on chest examination

Investigation:

• CXR
• Culture (sputum or bronchial washings)
• ABG

Management:

Prophylaxis:

• Do not undertake elective surgical procedures in the presence of uncontrolled respiratory infection
• In the postoperative period, provide adequate postoperative analgesia, physiotherapy and early mobilisation

Treatment:

• Initial administration of oxygen with the aim of restoring normal blood gas tensions
• Antibiotic administration:
• A combination of penicillin and erythromycin is a common first-line treatment which can be altered on the outcome of sputum culture

• Drainage of focal collections (e.g. purulent pleural effusion or an empyema)