Lung ultrasound-guided protocolized fluid management versus conventional central venous pressure-based management in monitoring extravascular lung water during the perioperative period of percutaneous nephrolithotomy: a randomized controlled trial.
Xuan Yu, Zhiwei Wang, Xinpeng Xu et al.
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In 30 seconds
This randomized controlled trial compared lung ultrasound (LUS)-guided protocolized fluid management with conventional central venous pressure (CVP)-based management in 181 patients undergoing elective percutaneous nephrolithotomy. Within 30 minutes after surgery, the LUS group had a significantly lower incidence and severity of increased extravascular lung water (EVLW) and a lower rate of postoperative hypoxemia than the CVP group (all p < 0.001). Extubation time and post-anesthesia care unit stay were also significantly shorter in the LUS group (p < 0.05).
Key findings
- The LUS-guided group had lower incidence and severity of EVLW increase within 30 minutes postoperatively than the CVP-based group (all p < 0.001).
- Postoperative hypoxemia was less frequent with LUS-guided management (p < 0.001).
- Extubation time and PACU stay were shorter in the LUS group (p < 0.05).
- LUS scores and CVP values were lower in the LUS group at T1, T2, and T3 (p < 0.001).
Why it matters
Irrigation-fluid absorption during PCNL can increase EVLW, making perioperative fluid assessment relevant to respiratory outcomes. In this randomized comparison, a protocol combining real-time LUS assessment with predefined intervention thresholds was associated with less postoperative EVLW increase and hypoxemia, as well as shorter early recovery measures. These findings support further consideration of ultrasound-based monitoring in this operative setting.
What to keep in mind
The abstract reports short-term perioperative outcomes, with EVLW assessed within 30 minutes postoperatively; it does not provide longer-term outcomes or numerical effect sizes.