Video double-lumen endotracheal tube reduces hypoxemia during one-lung ventilation in thoracoscopic surgery: a...

Compared to the conventional double-lumen endotracheal tube (c-DLT), the video double-lumen endotracheal tube (v-DLT) demonstrates a shorter intubation time and the capability of observing and adjusting malposition at any time. Our objective was to compare the incidence of hypoxemia during one-lung ventilation (OLV) and perioperative complications between the two tube types.

This single-center, prospective, randomized controlled trial enrolled 100 patients undergoing video-assisted thoracic surgery (VATS), who were randomized to receive either a v-DLT or a c-DLT. The primary outcome was the incidence of hypoxemia [defined as a peripheral oxygen saturation (SpO₂) below 90%] during OLV. A predefined rescue protocol was initiated if SpO₂ fell below 95%. Secondary outcomes included the number of hypoxemia-triggered interventions during OLV, postoperative complications, and anesthesiologist satisfaction.

The incidence of hypoxemia during OLV was significantly lower in the v-DLT group compared to the c-DLT group [3/48 (6.3%) vs. 13/47 (27.7%), P=0.006]. The v-DLT group also required fewer rescue interventions for SpO₂ <95% (35.4% vs. 66.0%, P=0.006) and less frequent fiberoptic bronchoscopy (FOB) use (P<0.001). Anesthesiologists reported higher satisfaction, reduced workload, and shorter intubation time with v-DLT (all P<0.001). There were no significant differences in postoperative complications between the two groups.

The use of v-DLT significantly reduces the incidence of hypoxemia during OLV, decreases the need for rescue interventions and FOB. Simultaneously, it improves procedural efficiency and enhances anesthesiologist satisfaction.

Chinese Clinical Trial Registry ChiCTR2100046484.