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.
- 1Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Abstract
Background
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.Methods
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.Results
Compared with Group C, Group LUS demonstrated significantly lower incidence and severity of EVLW increase within 30 min postoperatively, as well as reduced postoperative hypoxemia rate (all p < 0.001). Group LUS displayed evidently lower LUS scores and CVP values at T1、T2 and T3 than Group C (p < 0.001). Moreover, extubation time and PACU stay in Group LUS were significantly reduced, compared to Group C (p < 0.05).Conclusions
An LUS-guided fluid management protocol integrating real-time EVLW assessment with predefined intervention thresholds outperformed conventional CVP-based management during the perioperative period of PCNL. The superior sensitivity of LUS for detecting early EVLW elevation, combined with protocolized early intervention, reduced postoperative hypoxemia incidence, shortened extubation time and PACU stay duration, and improved short-term perioperative recovery.
Related
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- Ultrasonic-With-Ballistic Versus Pneumatic Lithotripsy in Percutaneous Nephrolithotomy for 2-4 cm Renal Calculi: A Prospective Quasi-experimental Comparative Study in a Bangladeshi Tertiary-Care Hospital
- Gentamicin-Augmented Intrarenal Irrigation During Percutaneous Nephrolithotomy Reduces 30-Day Infectious Complications and Eliminates Pyelonephritis and Sepsis: A 1:2 Matched Cohort Study
BibTeX
@article{yu2026lung,
title = {{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.}},
author = {Xuan Yu and Zhiwei Wang and Xinpeng Xu and Yu Shuai and Wen Cheng and Zhao Wang and Yi Zhang},
journal = {Annals of medicine},
year = {2026},
month = oct,
doi = {10.1080/07853890.2026.2741437},
url = {https://europepmc.org/article/MED/42851149},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Xuan Yu
AU - Zhiwei Wang
AU - Xinpeng Xu
AU - Yu Shuai
AU - Wen Cheng
AU - Zhao Wang
AU - Yi Zhang
PY - 2026
DA - 2026/10/09
JO - Annals of medicine
DO - 10.1080/07853890.2026.2741437
UR - https://europepmc.org/article/MED/42851149
AB - Background 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.Methods 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.Results Compared with Group C, Group LUS demonstrated significantly lower incidence and severity of EVLW increase within 30 min postoperatively, as well as reduced postoperative hypoxemia rate (all p < 0.001). Group LUS displayed evidently lower LUS scores and CVP values at T1、T2 and T3 than Group C (p < 0.001). Moreover, extubation time and PACU stay in Group LUS were significantly reduced, compared to Group C (p < 0.05).Conclusions An LUS-guided fluid management protocol integrating real-time EVLW assessment with predefined intervention thresholds outperformed conventional CVP-based management during the perioperative period of PCNL. The superior sensitivity of LUS for detecting early EVLW elevation, combined with protocolized early intervention, reduced postoperative hypoxemia incidence, shortened extubation time and PACU stay duration, and improved short-term perioperative recovery.
SN - 0785-3890
SN - 1365-2060
ER -