How Is Pneumonia Prevented After Heart Surgery?

Pneumonia after heart surgery is largely preventable. Patients start breathing exercises with a physiotherapist and are usually walking within a day or two. Meanwhile the breastbone heals. The same steps continue at home. Patients and families need to know them.

According to Dr. Vishal Khullar, a Cardiac Surgeon in Mumbai, “After a chest incision, every deep breath hurts a little, so people breathe shallowly. Small areas of the lung then collapse and mucus collects. That is where infection starts. Deep breaths, a firm cough and early walking cost nothing, and they do more to prevent it than most patients expect.”

Mucus left behind by a weak cough is the root problem. Pain is what keeps the cough weak.

• Shallow breathing: Along the breastbone, the incision tugs with every deep breath. Patients take small breaths instead. Parts of the lung can then collapse. This is called atelectasis. Trapped mucus is where infection can start.
• Breathing tube: During the operation, a tube in the windpipe connects the patient to a ventilator. Some patients need it for longer. In one study, more than 20 hours of ventilation roughly tripled the odds of pneumonia.
• Patient factors: People over 55 had a higher risk in that study. Diabetes and poor nutrition also raised it. Smoking damages the airways too.
• How common: Studies put the rate at roughly 2 to 10 percent of cardiac surgery patients. The first week carries the highest risk. One centre saw over half of its cases within 48 hours.

Operations through the breastbone, including heart bypass surgery, carry this lung risk.

Preventing lung infection post cardiac surgery is a long job. It begins before the operation and runs for weeks.

Breathing exercises: Let the physiotherapist show you the technique once. After that, it is on you. A round means 10 slow breaths, with a pause at the top of each. Do one round roughly every hour you are awake.

Coughing with support: Cough with a pillow hugged to the chest. That steadies the breastbone. Then cough properly. Check with the care team before you start.

Early movement: Expect the first walk on day one or two. Short distance, nurse alongside, drip stand rolling beside you. Sitting in a chair is part of it too. The head of the bed stays raised.

Before surgery: Smokers should stop the day the surgery date is fixed. Get any existing dental problems treated. Ask for breathing exercise training before the date. Both breathing physiotherapy and oral care have been linked to a lower risk of postoperative lung complications.

Daily habits during recovery are covered in this recovery guide.

Antibiotics clear most cases of pneumonia. Earlier is better. Families should watch for improvement in a few specific things. Knowing when to call the care team is part of it as well.

Treatment: Intravenous antibiotics come first. Test results guide which one. Oxygen is given if blood levels dip. Chest physiotherapy and fluids are common add-ons. The team also helps you cough.

Signs of improvement: Fever gradually subsides. Fewer coughing spells, each one looser. Each breath takes less effort. Your appetite returns. Oxygen support is reduced in steps.

Sleeping position: Raise the head and chest with a wedge or extra pillows. Flat on the back is the position to avoid early on. Sitting halfway up also spares the healing breastbone. Side sleeping comes back at 4 to 6 weeks for most.

Recovery time: The 4 to 6 week mark is when most people feel much better. Breastbone healing takes 8 to 12 weeks. If pneumonia develops, add 7 to 9 days in hospital.

Each week of recovery is mapped out in the weekly recovery guide.

Trapped mucus is the starting point for pneumonia after heart surgery. Use the spirometer, while supporting your chest with a pillow and walk early. Sitting upright also helps. Mouth care matters too. Report fever, a stubborn cough or breathlessness at rest to the care team promptly. Pneumonia is usually treated with antibiotics.

1. Wang K, et al. A nomogram predicting pneumonia after cardiac surgery: a retrospective modeling study. Journal of Cardiothoracic Surgery, 2024
2. Agency for Healthcare Research and Quality. Researchers Identify Risk Factors for Pneumonia After Cardiac Surgery, 2024

Disclaimer: This blog is for educational and informational purposes only and should not be considered professional advice.