Research progress in the application of double-lumen endobronchial tubes and bronchial blockers in thoracic surgery

With the rapid development of thoracic surgery toward minimally invasive and precise approaches, as well as the popularization of video-assisted thoracic surgery (VATS) and robot-assisted video-assisted thoracic surgery (RAVATS), higher requirements have been put forward for one-lung ventilation (OLV) technology during anesthesia. An ideal lung isolation technique not only needs to provide a good surgical field of view but also should minimize the incidence of airway injury, hypoxemia, and postoperative pulmonary complications (PPCs). Currently, double-lumen endobronchial tubes (DLTs) and bronchial blockers (BBs) are the two main tools for achieving OLV. This narrative review summarizes the development status and main surgical types of thoracic surgery in recent years, and analyzes the application of DLTs and BBs in operations such as pneumonectomy, esophageal surgery, and mediastinal surgery. Through a comprehensive comparison of high-quality randomized controlled trials and retrospective studies, the differences between the two airway management devices in terms of lung collapse quality, positioning time, incidence of airway injury, and postoperative recovery indicators are explored. Studies have shown that DLTs have advantages in lung isolation speed and bronchial suction efficiency, while BBs exhibit unique value in difficult airway management, reducing postoperative sore throat, and isolating specific lobes. Moreover, retrospective studies suggest a potential association between BBs use and lower PPCs rates, but this finding requires confirmation by high-quality randomized trials. This article aims to provide evidence-based airway management strategy references for thoracic surgeons and anesthesiologists when facing different surgical types and specific patients.