0
Correspondence |

Edict of Postoperative Fever and AtelectasisPostoperative Fever and Atelectasis FREE TO VIEW

Jason M. Kane, MD; Carl L. Backer, MD
Author and Funding Information

From the Department of Pediatrics (Dr Kane), Section of Critical Care Medicine, Rush University Medical Center; and the Department of Pediatric Cardiothoracic Surgery (Dr Backer), Northwestern University Feinberg School of Medicine.

Correspondence to: Jason Kane, MD, Rush University Medical Center, Department of Pediatrics, 1653 W Congress Pkwy, Murdock 622, Chicago, IL 60612; e-mail: jason_m_kane@rush.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):274-275. doi:10.1378/chest.11-1975
Text Size: A A A
Published online

To the Editor:

In their review and meta-analysis in a recent issue of CHEST (August 2011), Mavros and colleagues1 question the historical edict that postoperative fever is caused by atelectasis. The authors found little evidence to support the supposition that an association between fever and atelectasis actually exists. One limitation of the review acknowledged a paucity of data in the medical literature. A total of eight studies were included in their manuscript; however, only two specifically addressed the primary research question of association between atelectasis and fever.2,3 The first, by Engoren,2 was a blinded, nonrandomized study of 100 adult patients who underwent cardiac surgery that failed to show an association between fever and atelectasis on the first 3 postoperative days. The second study, by Pérez-Aispuro et al,3 was also a blinded nonrandomized study of adult patients undergoing abdominal surgery that failed to show an association between postoperative fever and atelectasis.

We recently reported on the largest cohort of pediatric patients, to our knowledge, aimed at specifically questioning the association between atelectasis and postoperative fever.4 In our study, 196 pediatric patients underwent analysis for association between postoperative fever and atelectasis. Radiologists were blinded to clinical data, and a radiographic scoring system similar to that of Engoren2 was used. Participants were stratified into groups based on demographic variables to increase the power to detect an association using the Cochran-Mantel-Haenszel test. We found no association between fever atelectasis on any postoperative day. We also found no relationship between the severity of atelectasis and highest daily temperature.

Although there are only a limited number of studies specifically addressing the association between atelectasis and postoperative fever, those data that do exist overwhelmingly demonstrate no association. Further, nearly all published studies uniformly recommend that the inclusion of atelectasis as a cause of postoperative fever be discarded as historical conjecture and unsupported dogma. Mavros and colleagues1 conclude that there is a need for additional large studies to precisely evaluate whether there is an association that the prior studies have not detected. We respectfully disagree, given the findings of our most recent study. From our perspective, based on our large cohort of patients and the outcome of our study, rather than performing additional studies, it would seem more prudent and appropriate to simply discard old dogma.

Mavros MN, Velmahos GC, Falagas ME. Atelectasis as a cause of postoperative fever: where is the clinical evidence? Chest. 2011;1402:418-424 [PubMed] [CrossRef]
 
Engoren M. Lack of association between atelectasis and fever. Chest. 1995;1071:81-84 [PubMed]
 
Pérez-Aispuro I, Pérez-Castro J, Avelar-Garnica F, Wacher-Rodarte N, Lifshitz-Guinzberg A. A reconsideration of postoperative fever due to pulmonary atelectasis [in Spanish]. Gac Med Mex. 1991;1271:27-30 [PubMed]
 
Kane JM, Friedman M, Mitchell JB, Wang D, Huang Z, Backer CL. Association between postoperative fever and atelectasis in pediatric patients. World J Ped and Congenital Heart Surg. 2011;23:359-363
 

Figures

Tables

References

Mavros MN, Velmahos GC, Falagas ME. Atelectasis as a cause of postoperative fever: where is the clinical evidence? Chest. 2011;1402:418-424 [PubMed] [CrossRef]
 
Engoren M. Lack of association between atelectasis and fever. Chest. 1995;1071:81-84 [PubMed]
 
Pérez-Aispuro I, Pérez-Castro J, Avelar-Garnica F, Wacher-Rodarte N, Lifshitz-Guinzberg A. A reconsideration of postoperative fever due to pulmonary atelectasis [in Spanish]. Gac Med Mex. 1991;1271:27-30 [PubMed]
 
Kane JM, Friedman M, Mitchell JB, Wang D, Huang Z, Backer CL. Association between postoperative fever and atelectasis in pediatric patients. World J Ped and Congenital Heart Surg. 2011;23:359-363
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543