From the Guidelines
Obese patients are at a higher risk of developing chronic atelectasis, which can lead to pleuritic chest pain due to the increased work of breathing and higher risk of perioperative atelectasis persisting for longer durations compared to patients with normal weight. Obesity creates conditions that predispose individuals to atelectasis through several mechanisms, including reduced lung expansion, particularly in the lower lobes, leading to shallow breathing patterns 1. This restricted ventilation allows secretions to accumulate and airways to close, especially when patients remain in one position for extended periods. Over time, these collapsed areas can become chronically underventilated, causing inflammation of the pleural lining and resulting in sharp, stabbing pain that worsens with deep breathing, coughing, or certain movements—classic symptoms of pleuritic chest pain.
Key factors contributing to this condition in obese patients include:
- Increased work of breathing
- Higher risk of perioperative atelectasis
- Restricted ventilation due to excess weight on the chest wall
- Accumulation of secretions and airway closure
- Chronic underventilation of collapsed lung areas
Management of chronic atelectasis in obese patients typically involves:
- Addressing the underlying obesity through weight loss strategies
- Encouraging deep breathing exercises and incentive spirometry
- Position changes every two hours
- Early mobilization
- Positive airway pressure therapy in some cases
- Adequate pain control to enable effective deep breathing, as pain from atelectasis may further limit respiratory effort, potentially worsening the condition if not properly addressed 1.
From the Research
Atelectasis in Obese Patients
- Atelectasis is a state of collapsed and non-aerated region of the lung parenchyma, which can occur due to various reasons such as airway obstruction, compression of parenchyma, and increased surface tension in alveoli and bronchioli 2.
- Obese patients are more prone to developing atelectasis, especially during general anesthesia, due to their altered respiratory mechanics and increased risk of airway closure 3, 4, 5, 6.
Relationship between Obesity and Atelectasis
- Studies have shown that morbidly obese patients have a higher incidence of atelectasis compared to non-obese patients, both before and after induction of general anesthesia 3, 4, 5, 6.
- The amount of atelectasis in obese patients can be significant, ranging from 7.6% to 11% of total lung volume, and can persist for at least 24 hours after surgery 5, 6.
Pleuritic Chest Pain and Atelectasis
- While the provided studies do not directly address the relationship between atelectasis and pleuritic chest pain in obese patients, it is known that atelectasis can cause chest pain and discomfort due to the collapse of lung tissue and the resulting inflammation 2.
- It is possible that obese patients with chronic atelectasis may experience pleuritic chest pain, although further research is needed to confirm this association.
Prevention and Treatment of Atelectasis
- Various strategies have been proposed to prevent and treat atelectasis in obese patients, including the use of positive end-expiratory pressure (PEEP), recruitment maneuvers, and ventilation with a moderate fraction of inspired oxygen 3, 4, 5.
- A recruitment maneuver followed by PEEP has been shown to be effective in reducing atelectasis and improving oxygenation in morbidly obese patients 5.