• Sherif Assaad, Tassos Kyriakides, George Tellides, Anthony W Kim, Melissa Perkal, and Albert Perrino.
• Cardiothoracic Anesthesia Service. Electronic address: sherif.assaad@yale.edu.
• J. Cardiothorac. Vasc. Anesth. 2015 Aug 1; 29 (4): 977-83.

ObjectiveThe 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.DesignA prospective observational study.SettingA single-center study.ParticipantsForty patients aged 18 years or older undergoing lung resection surgery.InterventionPatients 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.Measurements And Main ResultsThe 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.ConclusionIn 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.Published by Elsevier Inc.

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