Patients are weak and have painful wounds after surgery, and “coughing” seems to be an unbearable burden. The next morning after the operation, the nurses will be at the bedside to keep an eye on the patient coughing and coughing, not to be lazy. This is because the “little thing” of “coughing” is a big deal.
Why do we need to “cough” after surgery?
Pulmonary surgery is performed under general anesthesia.
Pulmonary surgery is performed under general anesthesia and tracheal intubation, and patients do not breathe on their own during surgery, so secretions in the airways cannot be expelled. So even if there is no sputum before surgery, there will inevitably be one or two mouthfuls of very sticky sputum after surgery.
Also, because of the surgical operation, the lung on the operated side collapses and becomes a deflated balloon, or “atelectasis,” by using one-lung ventilation (that is, leaving the operated lung unventilated and the non-operated side ventilated). At the end of the surgery, the surgeon will blow up the deflated lung again by double ventilation (that is, by turning the operated lung from non-ventilated to ventilated), but not all patients will be able to reopen well after surgery.
Also, postoperative anesthesia results in a weaker cough reflex, a longer time lying flat on the floor after returning to the ward, and poor sputum expulsion, which can easily form crusts in the airways and increase the risk of infection.
In summary, the goal of postoperative coughing is to cough up sputum as soon as possible to keep the airway open and clean. At the same time, the correct coughing exercises encourage lung expansion, prevent pulmonary atelectasis, and minimize the impact of surgery on lung function.
Coughing to expel sputum, this is the correct position
1. Use your breath to cough
The first thing is to sit up and keep your upper body in an upright position. Some patients coughing with their throat after surgery can be heard as if it is just their throat making an effort and not very effective in expelling phlegm. Always remember to let your stomach or chest cavity come under pressure when coughing up sputum. We suggest you try this: take a deep breath in, then make a small, even “a” sound, then exhale with your stomach, and you will find yourself “coughing” out. The family members can also feel it.
2. Stimulating the tracheal cough
You can also induce a cough by stimulating the airways. This is done by taking a deep breath and the doctor squeezing the trachea with his fingers from the upper sternal fossa to the sides. After the nerves around the trachea feel the stretch, it sometimes makes people cough involuntarily for a while, but not everyone is sensitive to the reaction.
Postoperative “coughing practice”, timing is important
You may ask: Can I cough when I’m not in pain and have strength after the first two days after surgery?
No.
The timing of the exercise is important. If phlegm is deposited in the airways and cannot be expelled, it can easily cause lung infections and even endanger lives. Also, if the lungs do not reopen after surgery, it will cause chest tightness, shortness of breath, dyspnea, and hypoxemia. As time lengthens, lung reopening will become more and more difficult and the results will become less and less effective. Therefore, you are encouraged to cough actively and correctly to exercise your lung function, regardless of whether you have sputum or not. Some patients have a cough before surgery and suddenly feel that they “won’t” after surgery. This is usually due to some electrical damage to the nerves that control coughing during surgery, or vocal cord paralysis from intubation. Don’t worry, it usually resolves in a few days.
In the meantime, your doctor will take into account your lack of energy and pain after surgery and give you the appropriate amount of pain medication, and if necessary, ask for a consultation with a rehabilitation or nutrition doctor to give you more specialized guidance on sleep, psychology, and nutrition. The first thing you need to do is to save your strength and cough.
Family members should also cooperate with the doctor and encourage the patient, and not allow the patient to be “lazy” because they are worried about their loved one’s “suffering”. The first thing you need to do is to make sure that you have a good idea of what you are doing. The way and intensity of the back patting needs to be done under the guidance of the nurse and doctor.
Of course, some patients may have sputum that cannot be coughed up or poorly expanded lungs, despite their best efforts, due to limitations such as disease, procedure, age, physical strength, and tolerance level. The doctor will use tracheoscopic aspiration and other means to help you to expel sputum and lung re-expansion as appropriate. As long as you cooperate well and exercise actively, you will be able to get through the “cough” hurdle!
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Liao Riqiang, Associate Director Dr. Dong Song Dr. Xia Jin
Co-Author: Dr. Wang Xing, Peking University Cancer Hospital