Impact of lung ultrasound-guided fluid management and vasoactive medication use on anaesthetic outcomes in thoracic surgery for tuberculous empyema: A retrospective study.

INTRODUCTION: Anaesthetic management of thoracic surgery for tuberculous empyema is complex, with traditional fluid strategies often causing intraoperative hypotension or volume overload. Lung ultrasound (LUS) provides real-time assessment of pulmonary fluid status, but its combined effect with prophylactic vasopressor support on anaesthetic outcomes in this population is unclear. This study aimed to evaluate the impact of an integrated strategy combining LUS-guided goal-directed fluid therapy and prophylactic vasopressor support on intraoperative haemodynamics and early post-operative recovery in patients undergoing thoracic surgery for tuberculous empyema. PATIENTS AND METHODS: This retrospective cohort study included patients who underwent elective decortication for tuberculous empyema between January 2022 and June 2025. Patients were categorised into the LUS-guided group (LGG) and conventional management group. After 1:1 propensity score matching, 40 patients per group were analysed. Primary outcomes included intraoperative hypotension (mean arterial pressure <65 mmHg for >5 min), while secondary outcomes assessed fluid balance, norepinephrine use, recovery time, pain and post-operative complications. RESULTS: The LGG had a significantly lower incidence and shorter duration of intraoperative hypotension ( P < 0.05). Intraoperative management showed reduced fluid balance, norepinephrine use and fewer vasopressor interventions in the LGG ( P < 0.01). Post-operative recovery was faster, with earlier ambulation and shorter hospital stays ( P < 0.001). The LGG also had lower pain scores and fewer pulmonary complications ( P < 0.05). Multivariable analysis confirmed that the LUS-guided strategy was independently associated with earlier ambulation (β = 6.798, P < 0.001), lower pain scores at rest (β = 0.589, P = 0.018) and reduced pulmonary complications (odds ratio = 3.713, P = 0.049) after adjusting for confounders. Multivariable analysis confirmed the LUS-guided strategy as an independent protective factor against intraoperative hypotension. Diabetes and thoracotomy approach were identified as independent risk factors ( P < 0.05), while fibrous stage empyema showed a trend toward significance ( P = 0.050). CONCLUSION: LUS-guided fluid management with prophylactic vasopressor support enhances intraoperative stability, optimises fluid and vasopressor use and accelerates recovery in thoracic surgery for tuberculous empyema.