CASE BASED

LEARNING
POSTOPERATIVE FEVER
POD# 1=Wind

Dr.B.Selvaraj MS;Mch;FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia
 CASE BASED
LEARNING
66 years old woman underwent hemi-colectomy after a perforation
due to diverticulitis.

The patient is on postoperative day 1 and complains of cough and

is noted to have fever.

She was intubated for the procedure with a laryngeal mask

airway.

Vitals: BP 130/80; HR102; RR19; T 101*

O/E: Dull on percussion over LLL area; Breath sounds diminished

 CASE BASED LEARNING

 What is your diagnosis?

 Fever in postop day 1 to 3 is due to Atelectasis or Pneumonia
Mnemonic:
 Wind – POD # 1 to 3  Atelectasis & Pneumonia
 Water – POD # 3 to 5 CA- UTI
 Walking- POD# 4 to 8 DVT & PE
 Wound-POD# 5 to 7 SSI
 Wonder drugs- anytime  Drug fever
 CXR- ATELECTASIS

 What is the
best next
step?

- CXR- PA and
lateral views

- Post-op
Atelectasis
 CXR- PNEUMONIA

 What is
the best
next step?

- CXR- PA
and lateral
views

- Post-op
Pneumonia
 Post-op fever POD#1
ATELECTASIS PNEUMONIA

DEFINITION Collapse of the lung resulting in Pneumonia is an inflammation of the

imbalance in gas exchange lung tissue as a result of bacterial, viral
or other infection.

ETIOLOGY Due to hypoventilation in GA or Complication of atelectasis or

decreased diaphragmatic movement aspiration. #1 cause for postop
due to surgical site pain morbidity and mortality. #3 cause for
postop complications behind SSI & UTI

PRESENTATIO Fever, tachypnea, tachycardia, dull Fever, tachypnea, tachycardia, AMS &
N on percussion over affected area and cyanosis in severe cases; Decreased
decreased breath sounds. breath sounds, rales & rhonchi,
egophony, dullness on percussion
 Post-op fever POD#1
ATELECTASIS
INVESTIGATION CXR- opacity over affected area
S - compensatory translucency
- ILS hemidiaphragm elevation
- mediastinal shift to same side
ABG & Helical CT chest
TREATMENT - Adequate pain control
- Incentive spirometry for
prophylaxis
- Chest physiotherapy
- No need for antibiotics
- Non invasive +ve pressure
ventilation like CPAP or BiPAP
PNEUMONIA
CXR- opacity over affected area
Sputum- C & S
ABG, CBC, CRP
- Broadspectrum antibiotics according
to C&S; No role for spirometry
- Empirically anti Pseudomonal
antibiotics like Ceftazidime,
Piperacillin- tazobactum, Imipenum,
meropenum Etc
- Anti MRSA antibiotics like
Vancomycin& Linazolid
 Post-op fever POD#1
RISK FACTORS:
 Age > 50 years
 Duration of surgery > 3 hrs
 Post-op GCS < 15
 Duration of Post-op ETT > 48hrs
 Tracheostomy
 Mechanical ventilation
 ICU stay > 5 days
THANK YOU

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