Li Hui, Chu Lihua, Ye Hui, Zhang Yixiao, Li Min, Hua Yejing, Zhang Jinhua, Hu Huiyi, Wen Tingting, Zhao Jie, Wan Haifang, Huang Lixia, Lou Yi, Tang Jing, Yan Zhenyi, Duan Gongchen, Wu Jimin, Wang Chuanguang, Lu Yaping, Shen Xu, Huang Cuiwan, Song Cheng, Wang Yan, Zeng Congli, Xie Guohao, Fang Xiangming
Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Anesthesiology, Hangzhou Red Cross Hospital, Hangzhou, China.
J Clin Anesth. 2025 Jun;104:111869. doi: 10.1016/j.jclinane.2025.111869. Epub 2025 May 13.
Study objective Accurate bronchial blocker placement is essential for effective lung isolation during thoracic surgery. Approximately one-third of patients experience bronchial blocker malposition during the transition from the supine to lateral decubitus position. It has been unclear whether bronchial blocker placement directly in the lateral position can reduce the incidence of malposition. This study investigated the incidence of bronchial blocker malposition in the lateral versus supine position and evaluated the effectiveness of lateral placement.
Adults aged ≥18 years scheduled for thoracic surgery were enrolled.
Seven tertiary hospitals in China.
Bronchial blockers were placed either in the lateral or supine position.
The primary outcome was the incidence of bronchial blocker malposition. Secondary outcomes included the times of bronchial blocker reposition, perioperative complications, intubation duration, and satisfaction scores.
Among 324 patients who underwent randomization, 306 completed the study (152 in the lateral group and 154 in the supine group). The incidence of bronchial blocker malposition was significantly lower in the lateral group (1/152 (0.7 %)) than in the supine group 39/154 (25.3 %), P < 0.001). The times of bronchial blocker reposition was also lower in the lateral group (median [interquartile range]: 0 [0,0]) than in the supine group (1.0 [1.0, 2.0], P < 0.001). Lateral bronchial blocker placement was associated with lower incidences of postural injury (P < 0.001). The median intubation duration (single-lumen tube intubation plus bronchial blocker placement) was similar between the two groups (P = 0.089). Patients and surgeons reported higher satisfaction scores in the lateral group (P < 0.001).
Lateral bronchial blocker placement reduced the incidence of malposition in patients undergoing thoracic surgery; it was associated with fewer complications and higher satisfaction scores. These findings indicate that lateral placement is an effective approach with substantial advantages over conventional supine placement. Clinial trial registration:NCT05482230.
研究目的 在胸外科手术中，准确放置支气管封堵器对于有效的肺隔离至关重要。在从仰卧位转换为侧卧位的过程中，约三分之一的患者会出现支气管封堵器位置不当的情况。尚不清楚直接在侧卧位放置支气管封堵器是否能降低位置不当的发生率。本研究调查了侧卧位与仰卧位支气管封堵器位置不当的发生率，并评估了侧卧位放置的有效性。
纳入计划进行胸外科手术的≥18岁成年人。
中国的七家三级医院。
支气管封堵器分别在侧卧位或仰卧位放置。
主要结局是支气管封堵器位置不当的发生率。次要结局包括支气管封堵器重新定位的次数、围手术期并发症、插管持续时间和满意度评分。
在324例接受随机分组的患者中，306例完成了研究（侧卧位组152例，仰卧位组154例）。侧卧位组支气管封堵器位置不当的发生率（1/152（0.7%））显著低于仰卧位组39/154（25.3%），P<0.001。侧卧位组支气管封堵器重新定位的次数也低于仰卧位组（中位数[四分位间距]：0[0,0]）比仰卧位组（为1.0[1.0,2.0]，P<0.001）。侧卧位放置支气管封堵器与较低的体位性损伤发生率相关（P<0.001）。两组之间的中位插管持续时间（单腔气管插管加支气管封堵器放置）相似（P=0.089）。患者和外科医生报告侧卧位组的满意度评分更高（P<0.001）。
侧卧位放置支气管封堵器降低了胸外科手术患者位置不当的发生率；它与更少的并发症和更高的满意度评分相关。这些发现表明，侧卧位放置是一种有效的方法，比传统的仰卧位放置有显著优势。临床试验注册号：NCT05482230。
