---
title: "Lung ultrasound–guided protocolized fluid management vs CVP-based care for monitoring extravascula"
id: "pubmed-42851149"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42851149"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42851149/"
doi: "10.1080/07853890.2026.2741437"
published_at: "2026-10-09T09:34:22.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Lung ultrasound–guided protocolized fluid management vs CVP-based care for monitoring extravascula
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42851149
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42851149/)
- **DOI:** [10.1080/07853890.2026.2741437](https://doi.org/10.1080%2F07853890.2026.2741437)
- **Published At:** 2026-10-09T09:34:22.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This randomized controlled trial compared **lung ultrasound (LUS)**–guided, protocolized fluid management with conventional **central venous pressure (CVP)**–based management in patients undergoing percutaneous nephrolithotomy (PCNL). 181 elective PCNL cases were randomized to Group C (CVP-based) or Group LUS (LUS-guided protocolized management). - The study assessed perioperative **extravascular lung water (EVLW)** by LUS and recorded incidence and severity of EVLW increase within 30 minutes postoperatively, plus postoperative hypoxemia. - Secondary measures included CVP values and LUS scores at predefined timepoints: before irrigation (T0), at the first administration of furosemide (T1), after irrigation (T2), and on leaving the PACU (T3). - Fluid volumes (crystalloid, colloid, total infusion, irrigation, and supplemental fluid at first furosemide administration), total furosemide dose, anesthesia time, surgical duration, PACU stay, extubation time, and total hospital stay were recorded. - Group LUS had a significantly lower incidence and severity of EVLW increase within 30 minutes postoperatively and a lower rate of postoperative hypoxemia compared with Group C (all p < 0.001). - Group LUS showed lower LUS scores and CVP values at T1, T2, and T3 than Group C (p < 0.001). - Extubation time and PACU stay were shorter in Group LUS versus Group C (p < 0.05). - The authors conclude that an LUS-guided protocol combining **real-time EVLW** assessment with predefined intervention thresholds outperformed conventional CVP-based management for perioperative fluid control during PCNL, improving early detection of EVLW elevation, reducing hypoxemia, and shortening extubation time and PACU stay. - Safety outcomes and perioperative complication rates were recorded; specific complication data were not reported in the abstract. - Keywords reported: **lung ultrasound**, **central venous pressure**, **extravascular lung water**, **fluid management**, **percutaneous nephrolithotomy**.
## Clinical Analysis & Structured Key Points
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Epub 2026 Oct 9. # Lung ultrasound-guided protocolized fluid management versus conventional central venous pressure-based management in monitoring extravascular lung water during the perioperative period of percutaneous nephrolithotomy: a randomized controlled trial [Xuan Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+X&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#full-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Zhiwei Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Z&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#full-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Xinpeng Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+X&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#full-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Yu Shuai](https://pubmed.ncbi.nlm.nih.gov/?term=Shuai+Y&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#full-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Wen Cheng](https://pubmed.ncbi.nlm.nih.gov/?term=Cheng+W&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#full-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Zhao Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Z&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#full-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Yi Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+Y&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#full-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.") Affiliations Expand ### Affiliation * 1 Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China. * PMID: **42851149** * DOI: [ 10.1080/07853890.2026.2741437 ](https://doi.org/10.1080/07853890.2026.2741437) Item in Clipboard Randomized Controlled Trial # Lung ultrasound-guided protocolized fluid management versus conventional central venous pressure-based management in monitoring extravascular lung water during the perioperative period of percutaneous nephrolithotomy: a randomized controlled trial Xuan Yu et al. Ann Med. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Ann Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ann+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42851149/) . 2026 Dec;58(1):2741437. doi: 10.1080/07853890.2026.2741437. Epub 2026 Oct 9. ### Authors [Xuan Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+X&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#short-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Zhiwei Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Z&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#short-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Xinpeng Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+X&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#short-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Yu Shuai](https://pubmed.ncbi.nlm.nih.gov/?term=Shuai+Y&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#short-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Wen Cheng](https://pubmed.ncbi.nlm.nih.gov/?term=Cheng+W&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#short-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Zhao Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Z&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#short-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China."), [Yi Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+Y&cauthor_id=42851149)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42851149/#short-view-affiliation-1 "Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.") ### Affiliation * 1 Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China. * PMID: **42851149** * DOI: [ 10.1080/07853890.2026.2741437 ](https://doi.org/10.1080/07853890.2026.2741437) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Percutaneous nephrolithotomy (PCNL) is a common surgical intervention to treat renal calculi. Excessive irrigation fluid absorption during surgery may enhance extravascular lung water (EVLW) level. Hence, accurate monitoring and protocolized management of EVLW are crucial for preventing postoperative complications. **Methods:** Our randomized controlled study enrolled 181 cases undergoing elective PCNL and randomly divided them to conventional CVP-based fluid management (Group C) or lung ultrasound-guided protocolized fluid management (Group LUS). Primary outcomes included increased incidence of EVLW and severity within 30 min postoperatively and postoperative hypoxemia in the two groups. Secondary outcomes were the CVP values and LUS scores at the following time points: before irrigation (T0), at the first administration of furosemide (T1), after irrigation (T2), and at the time of leaving the post-anesthesia care unit (PACU) (T3). Moreover, included fluid volumes (crystalloid, colloid, total infusion, irrigation, and supplemental fluid at first furosemide administration), total furosemide dosage. The anesthesia time, surgical duration, PACU stay time, extubation time, and total hospital stay were recorded. Safety outcomes included perioperative complication rates. **Results:** Compared with Group C, Group LUS demonstrated significantly lower incidence and severity of EVLW increase within 30 min postoperatively, as well as reduced postoperative hypoxemia rate (all _p_ < 0.001). Group LUS displayed evidently lower LUS scores and CVP values at T1、T2 and T3 than Group C (_p_ < 0.001). Moreover, extubation time and PACU stay in Group LUS were significantly reduced, compared to Group C (_p_ < 0.05). **Conclusions:** An LUS-guided fluid management protocol integrating real-time EVLW assessment with predefined intervention thresholds outperformed conventional CVP-based management during the perioperative period of PCNL. The superior sensitivity of LUS for detecting early EVLW elevation, combined with protocolized early intervention, reduced postoperative hypoxemia incidence, shortened extubation time and PACU stay duration, and improved short-term perioperative recovery. **Keywords:** Lung ultrasound; central venous pressure; extravascular lung water; fluid management; percutaneous nephrolithotomy. ## Plain language summary LUS-guided protocolized fluid management enables earlier detection of EVLW elevation than conventional CVP-based monitoring, allowing timely intervention during PCNL.Protocolized LUS-guided management significantly reduces postoperative EVLW severity and hypoxemia risk, while shortening extubation time and PACU stay duration.Integrating LUS as a non-invasive real-time monitoring tool within a structured management protocol optimizes perioperative fluid management and improves short-term recovery after PCNL. 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