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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 .
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PVI Guided Fluid Therapy | Active Comparator | Patients will receive PVI guided fluids during surgery PVI to be maintained below 12% if PVI >12 then colloid bolus 200ml will be given. Lung Ultrasonography will be performed post-intubation as baseline and at the end of surgery before extubation in 4 Lung zones in both lungs to measure total number of B-lines. |
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| CVP Guided Fluid Therapy | Active Comparator | Patients will receive Standard CVP Guided Fluids , CVP maintained between 10-16 cms H20 , if CVP< 10 then colloid bolus 200ml will be given. Lung Ultrasonography will be performed post-intubation as baseline and at the end of surgery before extubation in 4 zones in both lungs to measure total number of B-lines. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PVI Guided fluid management during surgery for (PVI<12) colloid bolus will be given . | Diagnostic Test | PVI probe attached to finger in PVI Group |
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| Measure | Description | Time Frame |
|---|---|---|
| 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 | End of surgery upto 1 hour |
| Measure | Description | Time Frame |
|---|---|---|
| Adequacy of Perfusion | Serum Blood Lactate levels will be measured at end of surgery in both groups. | End of surgery upto 1 hour |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Anita C Kulkarni, MD | Rajiv Gandhi Cancer Institute and Research Centre | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rajiv Gandhi Cancer Institute and Research Centre | Delhi | 110085 | India |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27174289 | Background | Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J. 2016 Jul 14;37(27):2097-104. doi: 10.1093/eurheartj/ehw164. Epub 2016 May 12. | |
| 28612302 | Background | Anile A, Russo J, Castiglione G, Volpicelli G. A simplified lung ultrasound approach to detect increased extravascular lung water in critically ill patients. Crit Ultrasound J. 2017 Dec;9(1):13. doi: 10.1186/s13089-017-0068-x. Epub 2017 Jun 13. |
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Participant was masked about Group it belonged
| CVP Guided Fluid management during surgery for CVP<10 cms H2O colloid bolus will be given | Diagnostic Test | Placement of central venous catheter |
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