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Post-Op Hypoxia Atelectasis Fluid Overload — FRCA Final MCQ

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ModeratePerioperative MedicinePost-Op Hypoxia Atelectasis Fluid OverloadFRCA Final

A 62-year-old man (ASA III) undergoes an emergency laparotomy for small bowel obstruction. Post-operatively he is admitted to ICU. On day 2, he develops a new oxygen requirement (FiO2 0.4 to maintain SpO2 94%). CXR shows bilateral basal atelectasis. Lung ultrasound shows B-lines bilaterally with small bilateral pleural effusions. What is the most likely cause?

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Correct answer: C — Pneumonia

Post-operative hypoxia with bilateral basal atelectasis and bilateral B-lines (indicating interstitial fluid/alveolar flooding) with small effusions on day 2 after major abdominal surgery is most commonly caused by a combination of atelectasis (from diaphragmatic splinting, pain, opioid-related hypoventilation) and perioperative fluid overload. B-lines on lung ultrasound indicate extravascular lung water. Management: chest physiotherapy, incentive spirometry, adequate analgesia (to enable deep breathing and coughing), sitting upright, judicious diuresis if fluid overloaded, and supplemental oxygen.

Reference: ICS – 2023 – Point-of-care lung ultrasound; RCOA – 2023 – Post-operative respiratory complications