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Extravascular Lung WaterNCT06141746

Ultrasound Assessment of Extravascular Lung Water in Patients Undergoing Percutaneous Nephrolithotomy

An observational study of Extravascular Lung Water and Percutaneous Nephrolithotomy, run by Assiut University.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Early detection of fluid accumulation in alveolar, interstitial and intracellular compartments of the lung due to intravascular absorption of irrigation fluid of PNL guided by lung ultrasound by detection of sonographic B lines. Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Lung ultrasound
Type of treatment
Medical device
How many people
100 participants
Where
No sites listed yet
Study dates
Apr 2024to Dec 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • Adult, Older adult

Study population: This study will be carried on patients who are undergoing percutaneous nephrolithotomy under general anesthesia between Nov.2023 and Nov.2024.

Who may be able to join

  • ASA Class I, II or III adult patients of age group 18-65 years. •Patient undergoing percutaneous nephrolithotomy.

Who cannot join

  • •Patients unable to provide written consent.
  • Patients less than 18 years or above 65 years.
  • ASA Class IV.
  • Patients previously diagnosed to suffer from interstitial lung disease.
  • patients who will receive intraoperative diuretics

Trial locations and contacts

No sites are listed yet.

About this study

Official title: Ultrasound Assessment of Irrigation Fluid Effect on Extravascular Lung Water in Patients Undergoing Percutaneous Nephrolithotomy

Early detection of fluid accumulation in alveolar, interstitial and intracellular compartments of the lung due to intravascular absorption of irrigation fluid of PNL guided by lung ultrasound by detection of sonographic B lines.

Read the detailed description

Study protocol:

Anesthetic technique:- After adequate pre-oxygenation for 3-5 min, General anesthesia will be induced by intravenous lidocaine 60 mg, propofol (2mg/kg) and cis-atracurium (0.15 mg/ kg) to facilitate endotracheal intubation by a cuffed endotracheal tube (size 6.5-7.5-mm), then the patient will be connected to mechanical ventilation which will be maintained with an 8 ml/ kg tidal volume, and ventilation frequency well be adjusted to maintain end-tidal CO2 between 30-35 mmHg. Anesthesia will be maintained with isoflurane (0.8-1.0%) in a mixture of oxygen and air (50:50%) and cis-atracurium (0.03 mg/ kg) and maintained every 20 min. Standard monitoring will be used intraoperatively including non-invasive arterial blood pressure, electrocardiography, end-tidal CO2, peripheral oxygen saturation and esophageal core temperature. Patients will receive one liter of normal saline infused over the first 2 hours intraoperatively as their fasting requirements and will be infused with 3 ml/kg/hour of Ringer's acetate as a maintenance fluid. Intraoperative hypotension (more than 20% decrease of the baseline of the patient ) will be treated by a bolus dose of crystalloid (4 ml/kg) as well as a bolus dose of ephedrine (3 mg). Atropine (0.5 mg) will be used to treat bradycardia if the heart rate is <60 beat/min. At end of surgery, isoflurane will be discontinued, and neuromuscular block will be antagonized using neostigmine (0.05 mg/kg) and atropine (0.02 mg/kg), intravenous paracetamol will be given as analgesia and boluses of fentanil Intraoperative as needed . Extubation will performed when patients began breathing spontaneously and were able to respond to verbal requests and discharge to post-Anesthesia Care Unit (PACU) but if the patient is not fulfilling criteria of extubation so discharge will be to Intensive care unit (ICU). If acute Postoperative lung congestion occurs with postoperative hypoxemia and desaturation, it will be treated with furosemide.

Blood samples will be collected for CBC, ABG and electrolytes as sodium and potassium Pre-operative, intraoperative and Immediately Post-operative.

Lung ultrasound scan technique: -

Each patient will be assessed for the presence of B-lines before induction of anesthesia and after end of anesthesia. A curved 2-6-MHz probe of Mindray machine will be used to do a series of scans with the patient in the supine position by applying the probe perpendicular to the skin over intercostal spaces along anatomical reference lines. More precisely, we will scan the anterolateral hemithoraxes along the parasternal, midclavicular, anterior axillary and mid-axillary lines. The left hemithorax will be scanned from the second to the fourth intercostal space, whereas the right lung will be scanned from the second to the fifth intercostal space, giving a total of 28 scanning sites. The edematous lung shows B-lines as vertical narrow bands originating from the pleural line and extending to the bottom of the image. A B-line score of ≤5 will be considered a normal sonographic pattern, since a few B-lines can be present in healthy subjects, especially above the diaphragm.

Data collection:- Patient characteristics

  • Age
  • Sex
  • Medical disease
  • Drug intake Operative data
  • Mean arterial blood pressure (MAP), heart rate and peripheral oxygen saturation during the following times (before induction of anesthesia, every 15 minutes after intubation, and at the end of surgery)
  • Intraoperative complication and interventions.
  • Duration of surgery
  • Duration of anesthesia
  • Type, volume and height of irrigation fluid.
  • Ultrasound guided extravascular lung water.

Postoperative data

  • Hemoglobin assessment.
  • Serum sodium level.
  • Serum potassium level.
  • Arterial blood gases (ABG).
  • Ultrasound guided extravascular lung water.

Statistical analysis:-

●Descriptive analysis Statistical analysis will be carried out by the SPSS statistical software package version 26.0 (IBM/SPSS, Inc., Chicago, IL). Baseline characteristics will be defined using descriptive statistics. Categorical variables were stated as an absolute number (n) and a relative frequency (%), and continuous variables will be represented as a median (interquartile range) or as a mean (± SD), depending on the normality of the distribution. The normality of distribution will be tested by the one-sample Kolmogorov-Smirnov test.

Being tested
Lung ultrasound

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Lung ultrasoundDevice

    Early detection of fluid accumulation in alveolar, interstitial and intracellular compartments of the lung due to intravascular absorption of irrigation fluid of PNL guided by lung ultrasound by detection of sonographic B lines.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Lung congestion

    Incidence of Post-operative lung congestion quantified by number of sonographic B-lines in anterolateral lung ultrasound scan in patients undergoing percutaneous nephrolithotomy.

    Measured: 1 hour postoperative

Secondary outcomes (3)
  1. Immediately Post-operative and after 24hours postoperative hemoglobin assessment.

    Immediately Post-operative and after 24hours postoperative hemoglobin assessment.

    Measured: 1 hour postoperative

  2. Immediately Post-operative and after 24hours postoperative serum sodium and potassium assessment.

    Immediately Post-operative and after 24hours postoperative serum sodium and potassium assessment.

    Measured: 1 hour postoperative

  3. Immediately Post-operative and after 24hours postoperative arterial blood gases (ABG) assessment.

    Immediately Post-operative and after 24hours postoperative arterial blood gases (ABG) assessment.

    Measured: 1 hour postoperative

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Nov 2023
  2. Study startApr 2024 (estimated)
  3. Primary completionNov 2024 (estimated)
  4. Study completionDec 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06141746
Sponsor's protocol ID
Extravascular lung water
Status last verified
Apr 2024
First submitted
20 Oct 2023
Last updated
16 Apr 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010 Spring;12(2-3):e86-96.

    PubMed 20811557
  • De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, Torricelli FC, Di Palma C, Molina WR, Monga M, De Sio M. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015 Jan;67(1):125-137. doi: 10.1016/j.eururo.2014.07.003. Epub 2014 Jul 23.

    PubMed 25064687
  • Rozentsveig V, Neulander EZ, Roussabrov E, Schwartz A, Lismer L, Gurevich B, Klein Y, Weksler N. Anesthetic considerations during percutaneous nephrolithotomy. J Clin Anesth. 2007 Aug;19(5):351-5. doi: 10.1016/j.jclinane.2007.02.010.

    PubMed 17869985
  • Gehring H, Nahm W, Zimmermann K, Fornara P, Ocklitz E, Schmucker P. Irrigating fluid absorption during percutaneous nephrolithotripsy. Acta Anaesthesiol Scand. 1999 Mar;43(3):316-21. doi: 10.1034/j.1399-6576.1999.430312.x.

    PubMed 10081538
  • Kukreja RA, Desai MR, Sabnis RB, Patel SH. Fluid absorption during percutaneous nephrolithotomy: does it matter? J Endourol. 2002 May;16(4):221-4. doi: 10.1089/089277902753752160.

    PubMed 12042103
  • Atici S, Zeren S, Aribogan A. Hormonal and hemodynamic changes during percutaneous nephrolithotomy. Int Urol Nephrol. 2001;32(3):311-4. doi: 10.1023/a:1017527126481.

    PubMed 11583340
  • Koroglu A, Togal T, Cicek M, Kilic S, Ayas A, Ersoy MO. The effects of irrigation fluid volume and irrigation time on fluid electrolyte balance and hemodynamics in percutaneous nephrolithotripsy. Int Urol Nephrol. 2003;35(1):1-6. doi: 10.1023/a:1025956810783.

    PubMed 14620272
  • Mohta M, Bhagchandani T, Tyagi A, Pendse M, Sethi AK. Haemodynamic, electrolyte and metabolic changes during percutaneous nephrolithotomy. Int Urol Nephrol. 2008;40(2):477-82. doi: 10.1007/s11255-006-9093-6.

    PubMed 17318347
  • Cordts PR, LaMorte WW, Fisher JB, DelGuercio C, Niehoff J, Pivacek LE, Dennis RC, Siebens H, Georgio A, Valeri CR, et al. Poor predictive value of hematocrit and hemodynamic parameters for erythrocyte deficits after extensive elective vascular operations. Surg Gynecol Obstet. 1992 Sep;175(3):243-8.

    PubMed 1514159
  • Grathwohl KW, Bruns BJ, LeBrun CJ, Ohno AK, Dillard TA, Cushner HM. Does hemodilution exist? Effects of saline infusion on hematologic parameters in euvolemic subjects. South Med J. 1996 Jan;89(1):51-5. doi: 10.1097/00007611-199601000-00008.

    PubMed 8545692
  • Guzelburc V, Balasar M, Colakogullari M, Guven S, Kandemir A, Ozturk A, Karaaslan P, Erkurt B, Albayrak S. Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm. Springerplus. 2016 Oct 4;5(1):1707. doi: 10.1186/s40064-016-3383-y. eCollection 2016.

    PubMed 27757377
  • Wang CH, Chen NC, Tsai MS, Yu PH, Wang AY, Chang WT, Huang CH, Chen WJ. Therapeutic Hypothermia and the Risk of Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore). 2015 Nov;94(47):e2152. doi: 10.1097/MD.0000000000002152.

    PubMed 26632746
  • Shin HJ, Na HS, Jeon YT, Park HP, Nam SW, Hwang JW. The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate: A prospective observational study using rotational thromboelastometry. Medicine (Baltimore). 2017 Jan;96(2):e5468. doi: 10.1097/MD.0000000000005468.

    PubMed 28079789

Questions about this trial

What is this clinical trial studying?

An observational study of Extravascular Lung Water and Percutaneous Nephrolithotomy, run by Assiut University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 16 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Hala A Hashem (01145502643, Halahashem797@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Lung congestion (time frame: 1 hour postoperative). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06141746, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Apr 2024.

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