Role of Lung Ultrasonography in Detecting Extravascular Lung Water in Major Oncosurgeries

Rajiv Gandhi Cancer Institute & Research Center, India120 enrolled

Overview

During major surgeries optimal intravenous fluid administration is essential , conventional method may cause fluid overload , increased extravascular Lung water can lead to postoperative cardio-respiratory complications , this study was designed to detect immediate postoperative EVLW with Lung Ultrasonography in patients receiving Central venous pressure Guided and Pleth variability Index (PVI) guided fluids intraoperatively .

Standard General Anaesthesia with Endotracheal Tube and Intermittent Positive Pressure Ventilation (IPPV) was given to all patients,Monitoring included 5 lead ECG, Oxygen Saturation (SPO2), End tidal Carbon di oxide (ETCO2), Invasive Blood Pressure (IBP) , Central venous Pressure (CVP), Pleth variability Index (PVI) in study group and Bispectral Index (BIS) , Core temperature .Postintubation before commencement of surgery baseline Lung Ultrasonography will be performed with non-linear probe in 4 zones on Right and Left Lung-- Zone I Right Midclavicular in second intercostal space , Zone II Right Parasternal in third intercostal space, Zone III Anterior axillary line in fourth intercostal space Zone IV Posterior axillary line in the V intercostal space. Zone V to VIII in Corresponding spaces on the Left side . In the control Group CVP Guided IV fluids were given during surgery CVP will be maintained between 10-16 cms H20 , for CVP values \< 10 cms H20 colloid bolus 200ml was given.In the Study Group PVI guided IV Fluids will be given to maintain PVI \<12 for increase in PVI value \> 12 Colloid bolus 200 ml will be given. After the completion of surgery and before extubation Lung Ultrasonography will be performed in all 8 Zones in both lungs to identify B Lines and total number of B lines will be calculated , Extra Vascular Lung Water (EVLW) Grading will be done as B Lines \<5 Mild, between 5-15 moderate , \> 15 severe .Total IV Fluids along with colloid boluses will be calculated , Postintubation as Baseline and after the completion of surgery Arterial blood gas analysis will be done for Alveolar-Arterial Oxygenation Pa02 (A-a) and blood Lactate values . After completion of surgery neuromuscular blockade will be reversed and trachea extubated .

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

SINGLE

Enrollment

120

Conditions

Extravascular Lung Water

Interventions

PVI Guided fluid management during surgery for (PVI<12) colloid bolus will be given .DIAGNOSTIC_TEST

PVI probe attached to finger in PVI Group

CVP Guided Fluid management during surgery for CVP<10 cms H2O colloid bolus will be givenDIAGNOSTIC_TEST

Placement of central venous catheter

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients undergoing major Oncosurgeries under General Anaesthesia Exclusion Criteria: * Left ventricular ejection fraction (LVEF )\< 40% * Chronic Obstructive Pulmonary Disease (COPD) * BMI \>30 * Lung fibrosis * Previous lung surgery

Locations (1)

Rajiv Gandhi Cancer Institute and Research Centre

Delhi, India

Outcomes

Primary Outcomes

Extravascular Lung Water detection

At the end of surgery before extubation Lung Ultrasonography will be performed in 4 Zones bilaterally to detect total number of B lines in both groups

Time frame: End of surgery upto 1 hour

Secondary Outcomes

Adequacy of Perfusion

Serum Blood Lactate levels will be measured at end of surgery in both groups.

Time frame: End of surgery upto 1 hour

Data from ClinicalTrials.gov

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