Extravascular lung water detected by ultrasound versus pulse pressure variation for intraoperative fluid management in kidney transplant surgery

Background For recipients of kidney transplants who have end-stage renal disease, intraoperative fluid control is crucial. Reliable parameters are needed to direct fluid management in these patients to reduce perioperative problems and enhance the result. So, our aim was to compare intraoperative fluid management during kidney transplant surgery using extravascular lung water identified by ultrasonography or pulse pressure change. Patients and methods This prospective randomized clinical trial was conducted in the operating rooms of ***** university hospitals (Kidney Transplant Unit). This study was carried out on 32 patients of both sexes, who underwent kidney transplant surgery. Patients were allocated into two groups: group (L): lung ultrasound group, which received lung ultrasound-guided fluid therapy, and group (P): pulse pressure variation (PPV) group, which received PPV-guided fluid therapy. Results There was a statistically significant difference between the two groups regarding fluid intake, urine output, sodium, calcium, magnesium, and creatinine on postoperative day 1, whereas the mean values of fluid intake, urine output, serum lactate, sodium, and creatinine were higher among group L, while the mean of calcium and magnesium were higher among group P. Conclusion PPV-guided protocol significantly reduced the total intraoperative intravenous fluid volume when compared with a protocol based on ultrasound assessment of extravascular lung water. Furthermore, this fluid restriction was achieved without adversely affecting key clinical outcomes, including hemodynamic parameters, urine output, 48-hour serum creatinine, and the 2-day post-transplant creatinine reduction ratio.