Early Detection of the Effect of Irrigation Fluid on Extravascular Lung Water in Patients Undergoing Transurethral Resection of a Prostate Using Bedside Lung Ultrasound
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 50
- 主要终点
- Incidence of intraoperative lung congestion quantified by number of sonographic B-lines in anterolateral lung ultrasound scan in patients undergoing TURP
研究概览
简要总结
Early detection of fluid accumulation in alveolar, interstitial, and intracellular compartments of the lung due to intravascular absorption of irrigation fluid of TURP guided by lung ultrasound by detection of sonographic B lines.
详细描述
Endoscopic syndrome or TURP (transurethral resection of a prostate syndrome (TURP)) syndrome is an undesirable effect of prostatectomy through the urethra. The reason is that the lavage used in endoscopy is hypotonic fluid, without electrolytes absorbed into the lumen through the prostate venous sinuses, changing the circulating volume, disturbing the water balance of electrolytes, especially hyponatremia, and reducing serum osmolality, affecting on the cardiovascular system, respiratory and nervous system.1 Symptoms of TURP are often irregular, asynchronous, and nonspecific. Sometimes life-threatening complications such as sudden coma, heart failure, cardiovascular collapse and, respiratory failure2,3 are reported. Recent studies show that the incidence of TURP ranges from 0.78% to 1.4%. Although there are not many severe cases of TURP, the mortality rate is up to 25%.4,5
The TURP syndrome is a clinical diagnosis based upon a constellation of symptoms and signs associated with excessive absorption of irrigating fluid into the circulation. It comprises acute changes in intravascular volume, plasma solute concentrations, and osmolality, and direct effects of the irrigation fluid used (glycine and its metabolites in the UK, as glycine 1.5% is the most common irrigation fluid used). The effects are proportional to the volume of irrigating solution absorbed. The presentation is not always uniform, and milder cases may be unrecognized. Other types of endoscopic surgery that require the use of irrigation solution, e.g., hysteroscopy, may also give increase to the TURP syndrome.3
Mild-to-moderate TURP syndrome may occur in 1-8% of patients.3 The overall mortality is 0.2-0.8%. It may present as early as 15 min after resection starts or as late as 24 h after operation.6 Severe TURP syndrome is now rare; however, it carries a mortality of up to 25%.3
Irrigation fluid is absorbed at a rate of between 10- and 30-ml min-1 of operating time.6 Five to 20% of patients will absorb >1 litre.3
A higher rate of absorption is produced by several factors.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- Male
- 接受健康志愿者
- 是
入选标准
- •• ASA Class I, II or III adult patients of age group 18-65 years.
- •Patient undergoing TURP.
排除标准
- •• 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
结局指标
主要结局
Incidence of intraoperative lung congestion quantified by number of sonographic B-lines in anterolateral lung ultrasound scan in patients undergoing TURP
时间窗: 1 year
Early detection of fluid accumulation in alveolar, interstitial, and intracellular compartments of the lung due to intravascular absorption of irrigation fluid of TURP guided by lung ultrasound by detection of sonographic B lines
次要结局
未报告次要终点
研究者
Monica Nabil Helmy Elcellini
Resident Doctor
Assiut University