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

Percutaneous nephrolithotomy (PCNL) is a common surgical intervention to treat renal calculi. Excessive irrigation fluid absorption during surgery may enhance extravascular lung water (EVLW) level. Hence, accurate monitoring and protocolized management of EVLW are crucial for preventing postoperative complications.

Our randomized controlled study enrolled 181 cases undergoing elective PCNL and randomly divided them to conventional CVP-based fluid management (Group C) or lung ultrasound-guided protocolized fluid management (Group LUS). Primary outcomes included increased incidence of EVLW and severity within 30 min postoperatively and postoperative hypoxemia in the two groups. Secondary outcomes were the CVP values and LUS scores at the following time points: before irrigation (T0), at the first administration of furosemide (T1), after irrigation (T2), and at the time of leaving the post-anesthesia care unit (PACU) (T3). Moreover, included fluid volumes (crystalloid, colloid, total infusion, irrigation, and supplemental fluid at first furosemide administration), total furosemide dosage. The anesthesia time, surgical duration, PACU stay time, extubation time, and total hospital stay were recorded. Safety outcomes included perioperative complication rates.