B-lines Score as Indicator for the Systemic Volumetric Load During TURP

Study Overview
=================
Brief Summary
-----------------
Lung Ultrasonography score (LUS) using B-lines is a noninvasive, reliable and promising method for determining the extravascular lung water (EVLW). This was previously evaluated by trans-pulmonary thermodilution technique. The transurethral resection of the prostate syndrome (TURP-S) is a potentially life-threatening complication of the TURP surgery and timely diagnosis of TURP-S is crucial for rapid detection and optimized treatment. This observational study is designed to investigate the use of LUS using B-lines as a bed-side, simple, and non-invasive indicator for predication of the presence of systemic volume overload in patients undergoing endoscopic TURP.

Official Title
-----------------
B-lines Score Derived From Lung Ultrasonography as a Noninvasive Indicator for the Systemic Volumetric Load During TURP. A Prospective Observational Study.

Conditions
-----------------
Transurethral Resection of Prostate

Intervention / Treatment
-----------------
* Device: Ultrasound


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age ≥ 60 years. American Society of Anesthesiologists Classification (ASA ) I, II, and III. Full conscious patients. Exclusion Criteria: Patient refusal. Who known allergic or hypersensitivity to any drug used in the study (local anesthesia). Coagulopathy (history of bleeding disorders), or patients on anticoagulant drugs, with (platelets <50,000 International Normalised Ratio( INR)>1.5). Patients have renal dysfunction patients with creatinine ≥ 2. Patients have uncontrolled cardiac diseases (IHD, (congestive heart failure (CHF), pulmonary hypertension and valvular diseases). Abdominal ascites. Patients with local infection at the site of local anesthetic injection. Failed spinal anesthesia. Timing not exceed 90 min. Any patient with lung ultrasound examination at T 0 ≥ 3 B-lines will be excluded from the study.

Ages Eligible for Study
-----------------
Minimum Age: 60 Years
Maximum Age: 90 Years

Sexes Eligible for Study
-----------------
Male

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Male patients with age ≥ 60 years undergoing TURP surgery<br>All patients will receive spinal anesthesia Under complete aseptic technique at level of L 4-L5 or L3-L4 using 12.5-15 mg of 0.5 % hyperbaric bupivacaine and 25 ug fentanyl. Lung ultrasound score: A curvilinear (5-2 MHz) probe will be used. The sliding multiple B-lines will be evaluated in eight antero-lateral lung examination zones. Inferior vena cava (IVC) measurement using ultrasound: A curvilinear (5-2 MHz) probe with B-mode scan will be used. Caval-Aorta index will be calculated by taking the ratio of the two respective diameters measured. Other vital parameter as ,heart rate (HR), Mean arterial pressure (MAP), oxygen saturation (SpO2), arterial blood gases (ABG), serum Na and K levels will be measured and recorded at same time as the following: (T0) ,(T1) ,(T2),(T3) ,(T30, T60, T90) intraoperative ,(T PACU),(T critical) | Device: Ultrasound<br>* LUS using B-lines Caval-Aorta index using ultrasound<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predictive ability of the LUS using B-lines for the presence of systemic volume overload in patients undergoing endoscopic TURP | using ultrasound | From the preoperative period (T0) to 60 min postoperative (T PACU) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predictive ability of the Caval-Aorta index as predictors of systemic volume overload in patients undergoing endoscopic TURP. | using ultrasound | From the preoperative period (T0) to 60 min postoperative (T PACU) | 
| Correlation between the absolute value of LUS, Caval-Aorta index . | using ultrasound | From the preoperative period (T0) to 60 min postoperative (T PACU) | 
| Correlation between the relative changes of the LUS and Caval-Aorta index | using ultrasound | From the preoperative period (T0) to 60 min postoperative (T PACU) | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Lung Ultrasonography score (LUS), extravascular lung water (EVLW), Transurethral resection of the prostate (TURP)