Extravascular Lung Water and Tissue Perfusion Biomarkers After Lung Resection Surgery Under a Normovolemic Fluid Protocol.
OBJECTIVE
The optimal fluid management for lung resection surgery remains undefined. Concern related to postoperative pulmonary edema has led to the practice of fluid restriction. This practice risks hypovolemia and tissue hypoperfusion. The authors examined the extravascular lung water accumulation and tissue perfusion biomarkers under protective lung ventilation and normovolemia.


METHODS
A prospective observational study.


METHODS
A single-center study.


METHODS
Forty patients aged 18 years or older undergoing lung resection surgery.


METHODS
Patients were maintained on protective lung ventilation and a normovolemic fluid protocol. Hemodynamic variables, including global end-diastolic volume index, cardiac index, and extravascular lung water index, together with tissue perfusion biomarkers, including serum creatinine, lactic acid, central venous oxygen saturation, and brain natriuretic peptide, were measured perioperatively. Parametric or nonparametric techniques were used to assess changes of these parameters over 72 hours postoperatively.


RESULTS
The global end-diastolic volume index was maintained; cardiac index was increased, without a significant change in extravascular lung water index. Acute kidney injury based on AKIN criteria occurred in 3 patients (7.5%), and in 1 patient (2.5 %) based on RIFLE criteria. Lactic acid and central venous oxygen saturation remained within normal limits, and brain natriuretic peptide showed an insignificant increase.


CONCLUSIONS
In patients undergoing lesser lung resections, a fluid protocol targeting normovolemia together with protective lung ventilation did not increase extravascular lung water. These results suggest further study to identify the optimal fluid regimen to mitigate pulmonic and extrapulmonic complications after lung resection.
Cardiothoracic Anesthesia Service. Electronic address: sherif.assaad@yale.edu.
Sherif
S
Assaad
Cardiothoracic Anesthesia Service.
Tassos
T
Kyriakides
Cardiac Surgery Service.
George
G
Tellides
Cardiac Surgery Service.
Anthony W
AW
Kim
Department of Surgery and Intensive Care, VA Connecticut Healthcare System and Yale University School of Medicine, New Haven, CT.
Melissa
M
Perkal
Cardiothoracic Anesthesia Service.
Albert
A
Perrino
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008168:Lung / Q000378:metabolism* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013510:Pulmonary Surgical Procedures / Q000379:methods / Q000639:trends*; D014018:Tissue Distribution / Q000502:physiology
D015415:Biomarkers
acute kidney injury; extravascular lung water; fluid therapy; lung resection