Lung ultrasound-guided fluids during PCNL reduced lung water and hypoxaemia

Design

Randomised controlled trial, single centre

Population

181 adults having elective percutaneous nephrolithotomy

Primary outcome

Extravascular lung water increase and postoperative hypoxaemia

Effect

Lower incidence and severity of lung water rise and less hypoxaemia with LUS (P < 0.001)

A randomised trial in Annals of Medicine assigned 181 patients having elective percutaneous nephrolithotomy to fluid management guided by central venous pressure or by a protocol using lung ultrasound to detect rising extravascular lung water, with predefined thresholds for action including furosemide.

The lung ultrasound group had a lower incidence and severity of increased lung water 30 minutes after surgery and less postoperative hypoxaemia (all P < 0.001). Lung ultrasound scores and CVP were lower at the later time points, and extubation and recovery room stays were shorter.

Absorption of irrigation fluid during PCNL can cause fluid overload, a particular risk in patients with reduced kidney function or heart failure. CVP is a poor guide to lung water; lung ultrasound detects it directly and earlier.

This was a single-centre trial and the abstract reports P values rather than effect sizes. It supports bedside lung ultrasound in long PCNL cases, especially in patients prone to fluid overload.

• Consider lung ultrasound to monitor fluid status during long PCNL procedures
• Be alert to irrigation fluid absorption in patients with CKD or heart failure
• Do not rely on CVP alone to judge lung water
• Agree action thresholds for diuretics with the anaesthetic team in advance

Why it matters

Irrigation fluid overload is a preventable complication in patients with limited kidney reserve.

Don't overread it

Single-centre trial with short-term outcomes; effect sizes were not reported in the abstract.

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