Atelectasis is not on the differential list of Early Post operative fever

The phenomenon of early post-operative fever (EPOF), generally accepted as fever within the first 48 h of surgery, is still being taught by many as related to ‘just a bit of pulmonary atelectasis. This is an outdated and non-evidencebased view.

In observational studies, it has been shown that there is no association between pulmonary atelectasis and Early post operative fever ( EPOF )after abdominal or cardiac surgery.

Reducing pulmonary atelectasis volume to less than half the size that seen in controls with regular deep breathing exercises during the first post-operative days does not affect the incidence of magnitude of Post Operative Fever (POF).

Surgery is followed by an acute-phase response, including immune and hypothalamo-pituitary-adrenal axis activation and increase in the plasma levels of IL6.

The systemic levels of IL-6 after abdominal, thoracic, vascular and maxillofacial surgery correlates significantly with postoperative body temperature increase. Likewise, patients may present with fever after major trauma.

Summary

The cause of EPOF is not pulmonary atelectasis but an appropriate metabolic response to surgical injury in most instances. Investigation of EPOF is low yielding and is likely to lead to inappropriate pharmacotherapy.

Engoren M. Lack of association between atelectasis and fever.

Roberts J, Barnes W, Pennock M, Browne G. Diagnostic accuracy of fever as a measure of postoperative pulmonary complications.

Schey D, Salom EM, Papadia A, Penalver M. Extensive fever workup produces low yield in determining infectious etiology.

Am. J. Obstet. Gynecol. 2005; 192: 1729–34.Heart Lung 1988; 17: 166–70.Chest 1995; 107: 81–4.

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