5 days) and is referred to as health care—related pneumonia. Aspiration of oropharyngeal and gastric contents is the leading cause of health care—related pneumonia. Presentation and Management The most common cause of a postoperative fever in the first 48 hours after the procedure is atelectasis. The patients have a low-grade fever, malaise, and diminished breath sounds in the lower lung fields. Very often the patient is uncomfortable from the fever but has no other overt pulmonary symptoms. Atelectasis is so common postoperatively that a formal workup is not usually required. However, if not aggressively managed, frank development of pneumonia is likely. A patient with pneumonia, on the other hand, will have a high fever, occasionally mental confusion, and the production of a thick secretion with coughing, leukocytosis, and a chest radiograph that reveals infiltrates. If the condition is not expeditiously diagnosed and treated, the patient may rapidly progress to respiratory failure and require intubation. Prevention of atelectasis and pneumonia is associated with pain control, which allows the patient to take deep breaths and cough. A patient-controlled analgesia device seems to be associated with better pulmonary toilet, as does the use of an epidural infusion catheter, particularly in patients with epigastric incisions. Respiratory care, otherwise, begins preoperatively. The patient must be instructed in the use of the incentive spirometer and be held accountable by nurses and physicians during rounds. Encouraging the patient to cough while applying counter pressure with a pillow on the abdominal incision site is most helpful. Rarely, other modalities such as intermittent positive pressure breathing and chest physiotherapy may be required. Encouraging the patient to breathe deeply and cough is the single most valuable management approach in preventing and resolving atelectasis and pneumonia. Patients in whom pneumonia develops in the postoperative period are managed with aggressive pulmonary toilet, induced sputum for culture and sensitivity testing, and empirical broad-spectrum IV antibiotic therapy while awaiting culture results. Once the organisms are cultured from sputum, a specific antibiotic must be used as indicated."">