Preventing Atelectasis: Incentive Spirometry, Breathing Exercises, and Mobility

Postoperative Atelectasis Risk

General anesthesia, opioids, immobility, and incisional pain → shallow breathing → alveolar collapse (especially dependent lung zones).

Evidence-Based Prevention

Incentive Spirometry (IS)

• Flow-oriented or volume-oriented device
• 10–15 breaths/session, 10 sessions/day (every hour awake)
• Goal: achieve predicted inspiratory volume
• Evidence: reduces atelectasis, pneumonia, length of stay after abdominal/thoracic surgery

Deep Breathing Exercises

• Diaphragmatic breathing: hand on abdomen, slow inspiration (4 sec), hold (3 sec), slow expiration (6 sec)
• 5–10 min/session, 4–6×/day
• Can be combined with IS

Early Ambulation

• Sit on edge of bed → stand → walk (post-op day 0–1)
• Target: 3+ walks/day, increasing distance
• Promotes lung expansion, V/Q matching, secretion clearance

Directed Coughing

• Splint incision (hands/pillow)
• Deep inspiration → forceful expiratory effort (not throat clearing)
• Repeat 3–5×/session, q2–4h

Adjunctive Measures

• Pain control (epidural, PCA, scheduled multimodal)
• Head of bed 30–45°
• Smoking cessation (preop ideally)
• Weight optimization
• Manage COPD/heart failure