From the Guidelines
Obesity-related atelectasis causes pleuritic chest pain primarily due to inflammation and stretching of the pleural membranes, as the excess weight compresses the lower lung regions, leading to lung collapse and an inflammatory response. When excess weight compresses the lower lung regions, portions of the lung collapse (atelectasis), preventing normal air exchange. This collapse creates an inflammatory response in the pleural lining as the body attempts to resolve the abnormal lung condition. According to the ERAS society recommendations, obesity is associated with increased work of breathing as well as higher risk of perioperative atelectasis persisting for longer duration compared to patients with normal weight 1.
The mechanical strain from the collapsed lung tissue pulling on the pleural attachments contributes to pain. When a patient breathes, the inflamed pleural surfaces rub against each other, causing the characteristic sharp, stabbing pain that worsens with deep breathing, coughing, or movement. Treatment typically involves addressing the underlying obesity through weight management, encouraging deep breathing exercises, incentive spirometry, and early mobilization to re-expand collapsed lung segments. A postoperative positioning in a head-elevated, semi-seated position prevents further development of atelectasis and may improve oxygenation 1.
Pain management may include NSAIDs like ibuprofen (400-600mg every 6 hours) or naproxen (500mg twice daily) to reduce inflammation. In severe cases, supplemental oxygen might be necessary, but it should be used with caution as it may increase the duration and time to detection of apnoea/hypopnoea as well as carbon dioxide retention 1. The condition improves as the atelectasis resolves and inflammation subsides, which can be accelerated by positional changes that reduce abdominal pressure on the diaphragm. Key considerations in management include:
- Weight management to reduce compressive forces on the lungs
- Deep breathing exercises and incentive spirometry to improve lung expansion
- Early mobilization to reduce the risk of further atelectasis
- Positional changes to reduce abdominal pressure on the diaphragm
- Judicious use of supplemental oxygen and pain management with NSAIDs.
From the Research
Obesity-Related Atelectasis and Pleuritic Chest Pain
- Obesity-related atelectasis can cause pleuritic chest pain due to the increased pressure on the lungs and chest cavity 2.
- Atelectasis, or the collapse of lung tissue, can lead to inflammation and irritation of the pleura, resulting in sharp, stabbing, or burning pain in the chest when inhaling and exhaling 3.
- The exact mechanism of pleuritic chest pain in obesity-related atelectasis is not fully understood, but it is thought to be related to the increased pleural pressure and the resulting stress on the lung tissue and surrounding structures 2.
Underlying Causes of Pleuritic Chest Pain
- Pleuritic chest pain can be caused by a variety of underlying conditions, including pulmonary embolism, myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax 3.
- In the context of obesity-related atelectasis, the pleuritic chest pain is likely related to the mechanical stress on the lung tissue and surrounding structures, rather than an underlying inflammatory or infectious process 2.
Diagnosis and Management of Pleuritic Chest Pain
- The diagnosis of pleuritic chest pain typically involves a combination of physical examination, medical history, and diagnostic testing, such as chest radiography and electrocardiography 3.
- The management of pleuritic chest pain depends on the underlying cause, but may include pain management with nonsteroidal anti-inflammatory drugs, as well as treatment of the underlying condition 3.
- In the case of obesity-related atelectasis, management may involve strategies to reduce pleural pressure and improve lung function, such as positive end-expiratory pressure (PEEP) and lung recruitment maneuvers 2.