- Design
- Prospective single-centre observational cohort
- Population
- 200 adults undergoing major gastrointestinal surgery
- Primary outcome
- Prevalence of reduced fluid tolerance on ultrasound
- Effect
- 37%; associated with stay >7 days (OR 3.29, 95% CI 1.03 to 10.70)
A single-centre observational study scanned 200 patients before and daily for five days after major gastrointestinal surgery, using lung ultrasound and venous excess ultrasound (VExUS) to detect congestion.
Signs of reduced fluid tolerance appeared in 37%, almost all as pulmonary B-lines rather than systemic venous congestion, most often on day four and usually for one day. Reduced fluid tolerance was associated with a stay longer than seven days (OR 3.29, 95% CI 1.03 to 10.70) but not with major complications. About one in eight planned scans were missed, mostly because patients declined repeat assessments.
This is a description of how often congestion occurs, not a test of whether acting on it helps. It supports bedside lung ultrasound as part of fluid assessment, not routine daily scanning.
- Consider lung ultrasound when deciding on further fluid after major abdominal surgery
- Watch for congestion around postoperative day four
- Weigh patient burden before planning repeated daily scans
- Combine ultrasound findings with clinical assessment rather than acting on one view
Why it matters
More than a third of patients showed congestion that clinical examination may not detect.
Don't overread it
Observational — it does not show that fluid restriction guided by ultrasound improves outcomes.
The statistics, in plain English
An OR of 3.29 has a wide interval (1.03 to 10.70) and only just excludes no effect. Longer stay may reflect sicker patients rather than congestion itself.
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