Crompton JG, Crompton PD, Matzinger P. Does Atelectasis Cause Fever After Surgery? Putting a Damper on Dogma. JAMA Surg. 2019 May 1;154(5):375-376.

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Figure. Damage-Associated Molecular Patterns (DAMPs) and Pathogen-Associated Molecular Patterns (PAMPs)

“The danger model of immunity challenges the premise of our current therapeutic approach in treating noninfectious causes of postoperative fever. The clinical benefit of interventions targeting atelectasis as a cause of postoperative fever, such as incentive spirometry, need to be reassessed. The first report of incentive spirometry as treatment for atelectasis was described in 1972. [1] Although still widely used, a Cochrane review [2] of 12 randomized clinical trials that included 1834 patients concluded that there is no evidence to support the use of incentive spirometry in preventing fever after surgery. We have limited focus here on the role of incentive spirometry to reduce fever after surgery, not other pulmonary complications, for which it may have clinical benefit.

The danger model provides an understanding of noninfectious postoperative fever that is not owing to atelectasis and does not require treatment with incentive spirometry. In the absence of symptoms or signs of infection such as leukocytosis, we believe that early postoperative fever can be attributed to DAMPs, not PAMPs—a physiologic self-limiting phenomenon that does not require therapeutic intervention.” (Crompton, 2019, p. 376)