Prevention and treatment of pulmonary complications in patients after surgery of the upper abdomen.

Pulmonary complications are the leading cause of morbidity and death during the postoperative period in patients who have undergone upper abdominal surgery. Significant pulmonary mechanical alterations, such as reductions in VC, TV, and FRC and an increase in CV, are noted postoperatively in this patient population. Preexisting patient conditions, postoperative treatments, and certain respiratory maneuvers may increase the patient's risk in the development of postoperative pulmonary complications. Current research unanimously advocates sustained maximal inspiration, the normal physiologic sigh maneuver, as the best method of prevention and treatment of this problem. Commonly utilized maneuvers, such as blowing into a rubber glove or bag, blow bottles, and the like, should be avoided in all situations. A guide for preoperative and postoperative pulmonary assessment and care based on current research is included. After consideration of the data in addition to personal clinical experience, I conclude that to prevent pulmonary complications in patients after upper abdominal surgery, as well as in all hospitalized patients, sustained maximal inspiration, preferably with an incentive spirometer, and conscientious nurse supervision and coaching is the method of choice.