relationship between respirations and fevers

[anonymousstudent]

I've heard several nurses at clinical encourage patients to cough and deep breathe as a corrective method for low grade fevers post-op (99/99.5ish).

I must have completely missed the pathology of this process, because I can't figure it out and I don't think I've ever heard it before. Why would respiration alter temperature? The only thing I could think of was that some mild infection is forming in the lungs, which trips the inflammation cascade and causes a slight elevation in temperature? So coughing and deep breathing clears the pathogens/infection and allows the body to return to normal? I'm totally guessing.

[dudette10, MSN, RN]

First, I wondered if it was just a common thing to do post-operatively with no evidence base. So, I went a-googling.

I found a thread for student doctors, and there is controversy about the notion of atelectasis=post op fever.

http://forums.studentdoctor.net/showthread.php?t=778018

Until more evidence is found, it is recommended to encourage coughing/deep breathing to prevent post-op atelectasis, but to associate that with reducing post-op fever doesn't have enough evidence to support it.

Pathophysiologically, I would be more inclined to believe that the trauma of surgery and the subsequent inflammatory response are more likely the culprit.

[dudette10, MSN, RN]

As for the infection part of post-op low-grade fever, I don't know. Would the antigen load post-op be enough for the body to respond with a temperature-related defense?

[anonymousstudent]

As for the infection part of post-op low-grade fever, I don't know. Would the antigen load post-op be enough for the body to respond with a temperature-related defense?

Good question. I wasn't clear how they were determining that the process was occurring in the lungs, and not just a normal physiological response to inflammation r/t surgery as is normal and expected.

I clarified with one nurse, because she directly told a client that the c/db would lower his fever. She said yes, of course, breathing deeply lowers the body temperature. I had a brief flash back to the 4 humors logic and then moved on thinking I had completely missed the boat on this one. I'm glad there's some controversy about it. I was at a very well known research/education hospital, so that worries me a little.

[shortnorthstudent]

I haven't looked for the evidence basis of incentive spirometry for post-surgical fever reduction. However, I have heard it on the floor quite often and have seen it appear to work several times.

[SafetyNurse1968, BSN, MSN, PhD]

We were just talking about this in the break room - so glad you posted! I was hypothesizing that the atelectasis in the lungs invited WBCs to swarm the area thinking there was an infection - deep breathing and coughing clears the atelectasis and thus brings down the fever - need to go do some more research!

thanks again