Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Anesthesiology, Wu'an First People's Hospital, Handan, China.
BMC Anesthesiol. 2024 May 20;24(1):179. doi: 10.1186/s12871-024-02567-w.
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.
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.
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 17.6 s [95% confidence interval (CI): 9.9 s to 25.3 s; P = 0.050], failing to demonstrate non-inferiority with a non-inferiority margin of 10 s. 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.
The lateral VDLT intubation took longer time than in the supine position, and non-inferiority was not achieved. The incidence of displacement as the secondary endpoint was lower in the L group, possibly due to changing body positions beforehand. The indication of lateral VDLT intubation should be based on a balance between the safety of airway management and the lower incidence of displacement.
The study was registered at Chictr.org.cn with the number ChiCTR2200064831 on 19/10/2022.
在侧卧位下进行视频双腔管（VDLT）插管是一种替代胸外科患者仰卧位插管的潜在方法。本非劣效性试验评估了侧卧位下 VDLT 插管的疗效和安全性。
接受右胸腔镜肺手术的患者（18-70 岁）被随机分配到左侧卧位组（L 组）或仰卧位组（S 组）。在视频喉镜下放置 VDLT。主要终点是插管时间。次要终点包括 VDLT 移位率、插管失败率、外科医生和护士的满意度以及与插管相关的不良事件。
分析共纳入 80 例患者。L 组总插管时间为 52.0[20.4]s，S 组为 34.3[13.2]s，平均差异为 17.6s[95%置信区间（CI）：9.9s 至 25.3s；P=0.050]，未能证明非劣效性，非劣效性边界为 10s。与 S 组相比，L 组 VDLT 移位率显著较低（P=0.017），护士满意度较高（P=0.026）。两组均未发生插管失败。插管并发症（P=0.802）和外科医生满意度（P=0.415）无差异。
与仰卧位相比，侧卧位 VDLT 插管时间较长，且未达到非劣效性。次要终点的移位发生率在 L 组较低，可能是由于之前改变了体位。侧卧位 VDLT 插管的适应证应基于气道管理的安全性和较低的移位发生率之间的平衡。
该研究于 2022 年 10 月 19 日在中国临床试验注册中心（ChiCTR2200064831）注册。
