Efficacy and safety of video double-lumen tube intubation in lateral position in patients undergoing thoracic surgery: A randomized controlled trial

Abstract

Abstract Background: Video double-lumen tube (VDLT) intubation in lateral position is a potential alternative to intubation in supine position in patients undergoing thoracic surgery. This non-inferiority trial assessed the efficacy and safety of VDLT intubation in lateral position. Methodsː Patients (18-70 yr) undergoing right thoracoscopic lung surgery were randomized to either the left lateral position group (group L) or the supine position group (group S). The VDLT was placed under video larygoscopy. The primary endpoint was the intubation time. Secondary endpoints included VDLT displacement rate, intubation failure rate, the satisfaction of surgeon and nurse, and intubation-related adverse events. Resultsː The analysis covered 80 patients. The total intubation time was 52.0 [20.4]s in group L and 34.3 [13.2]s in group S, with a mean difference of 17.6s [95% confidence interval (CI): 9.9s to 25.3s; P=0.050], failing to demonstrate non-inferiority with a non-inferiority margin of 10s. Group L, compared with group S, had significantly lower VDLT displacement rate (P=0.017) and higher nurse satisfaction (P=0.026). No intubation failure occurred in any group. Intubation complications (P=0.802) and surgeon satisfaction (P=0.415) were comparable between two groups. Conclusionsː VDLT intubation in lateral position was inferior to supine position in terms of intubation time. Given that no patient in group L suffered from hypoxia or intubation failure during intubation and group L had a lower VDLT displacement rate, it is possible that patients with a body mass index of less than 30 kg/m2, no cardiorespiratory disease, and no difficult airway could be successfully intubated using VDLT in lateral position. Trial registration number: ChiCTR2200064831; Registry URL: Chictr.org.cn; Registration Date: 19/10/2022