Extravascular Lung Water
Conditions
Keywords
Lung Ultrasonography Extravascular Lung Water Plethysmography variability Index
Brief summary
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 .
Detailed description
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 .
Interventions
DIAGNOSTIC_TESTPVI Guided fluid management during surgery for (PVI<12) colloid bolus will be given .
PVI probe attached to finger in PVI Group
DIAGNOSTIC_TESTCVP Guided Fluid management during surgery for CVP<10 cms H2O colloid bolus will be given
Placement of central venous catheter
Sponsors
Rajiv Gandhi Cancer Institute & Research Center, India
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Subject)
Masking description
Participant was masked about Group it belonged
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Extravascular Lung Water detection | End of surgery upto 1 hour | 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adequacy of Perfusion | End of surgery upto 1 hour | Serum Blood Lactate levels will be measured at end of surgery in both groups. |
Countries
India
Outcome results
None listed