Study of VExUS Ultrasound to Guide Fluid Management and Reduce Lung and Kidney Complications After Thoracic Surgery with One-Lung Ventilation

What this Trial Is About

Researchers are evaluating the impact of a VExUS ultrasound-guided fluid management protocol during thoracic surgery on the rates of postoperative lung complications and acute kidney injury. This study focuses on patients undergoing video-assisted thoracic surgery or lobectomy requiring one-lung ventilation, where fluid management is challenging due to risks like lung edema and kidney injury triggered by surgery and ventilation effects. The study aims to balance fluid administration to prevent both lung and kidney problems post-surgery. Participants are randomly assigned to one of two groups. The control group receives standard care with isotonic crystalloids at 3 mLkgh during surgery and recovery. The VExUS-guided group receives fluid management based on ultrasound assessments of venous congestion via the VExUS protocol, which measures inferior vena cava diameter and blood flow patterns in key veins to guide fluid and medication use. This includes tailored fluid boluses, diuretics, and fluid rates depending on congestion grades, and both groups receive treatment to replace blood losses and maintain hemoglobin levels. During the study, participants will undergo monitoring including invasive blood pressure, urine output, arterial blood gases, and respiratory parameters. Kidney function is assessed before surgery and on postoperative days 1 and 3 using filtration rates, biomarkers, and urine tests. Lung function and oxygen levels are measured preoperatively, during surgery, and after surgery. Researchers will track lung complications, kidney injury markers, fluid balance, and hemodynamic stability throughout hospitalization. The total participation duration covers preoperative assessment through the postoperative care unit and early recovery days.

Effect of VExUS Ultrasound Protocol (Venous Excess Ultrasound) on Perioperative Fluid Management, on the Incidence of Postoperative Pulmonary Complications and Postoperative Acute Kidney Injury in Patients Undergoing Thoracic Surgery