DLT intubation in VATS
Trial question
What is the role of lateral double-lumen tube intubation in patients undergoing video-assisted thoracic surgery?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
55.0% female
45.0% male
N = 106
106 patients (58 female, 48 male).
Inclusion criteria: patients undergoing video-assisted thoracic surgery.
Key exclusion criteria: history of pulmonary surgery; difficulty in intubation; severe mental illness.
Interventions
N=53 lateral group (receipt of double-lumen tube intubation in the comfortable and surgically required lateral position).
N=53 supine group (receipt of double-lumen tube intubation in the conventional supine position).
Primary outcome
Incidence of double-lumen tube malposition
2%
30%
30.0 %
22.5 %
15.0 %
7.5 %
0.0 %
Lateral
group
Supine
group
Significant
decrease ▼
NNT = 3
Significant decrease in incidence of double-lumen tube malposition (2% vs. 30%; RR 0.06, 95% CI 0.01 to 0.46).
Secondary outcomes
Significant decrease in median intubation time (78 seconds vs. 86 seconds; MD -20.6, 95% CI -36.2 to -5).
No significant difference in re-intubation (6% vs. 15%; RR 0.38, 95% CI 0.16 to 1.34).
Significant decrease in fiberoptic bronchoscopy usage > 2 (4% vs. 23%; RR 0.17, 95% CI 0.04 to 0.71).
Conclusion
In patients undergoing video-assisted thoracic surgery, lateral group was superior to supine group with respect to incidence of double-lumen tube malposition.
Reference
Xi Zhang, Dongxu Wang, Zhenduo Zhang et al. Effect of intubation in lateral position on placement of a double-lumen tube in patients undergoing unilateral video-assisted thoracic surgery: a randomied clinical trial. EClinicalMedicine. 2024 Jan 3:67:102402.
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