The effects of video double-lumen tubes on intubation complications in patients undergoing thoracic surgery: A randomised controlled study.
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
medline:
4
3
2024
pubmed:
1
2
2024
entrez:
1
2
2024
Statut:
ppublish
Résumé
Tracheal injuries, vocal cord injuries, sore throat and hoarseness are common complications of double-lumen tube (DLT) intubation. This study aimed to evaluate the effects of 'video double-lumen tubes' (VDLTs) on intubation complications in patients undergoing thoracic surgery. A randomised controlled study. Xuzhou Cancer Hospital, Xuzhou, China, from January 2023 to June 2023. One hundred eighty-two patients undergoing elective thoracic surgery with one-lung ventilation were randomised into two groups: 90 in the DLT group and 92 in the VDLT group. VDLT was selected for intubation in the VDLT group, and DLT was selected for intubation in the DLT group. A fibreoptic bronchoscope (FOB) was used to record tracheal and vocal cord injuries. The primary outcomes were the incidence of moderate-to-severe tracheal injury and the incidence of vocal cord injury. The secondary outcomes included the incidence and severity of postoperative 24 and 48 h sore throat and hoarseness. The incidence of moderate-to-severe tracheal injury was 32/90 (35.6%) in the DLT group, and 45/92 (48.9%) in the VDLT group ( P = 0.077; relative risk 1.38, 95% CI, 0.97 to 1.95). The incidence of vocal cord injury was 31/90 (34.4%) and 34/92 (37%) in the DLT and VDLT groups, respectively ( P = 0.449). The incidence of postoperative 24 h sore throat and hoarseness was significantly higher in the VDLT group than in the DLT group (for sore throat: P = 0.032, relative risk 1.63, 95% CI, 1.03 to 2.57; for hoarseness: P = 0.018, relative risk 1.48, 95% CI, 1.06 to 2.06). There was no statistically significant difference in the incidence of moderate-to-severe tracheal injury and vocal cord injury between DLTs and VDLTs. While improving the first-attempt success rate, intubation with VDLT increased the incidence of postoperative 24 h sore throat and hoarseness. Chinese Clinical Trial Registry identifier: ChiCTR2300067348.
Sections du résumé
BACKGROUND
BACKGROUND
Tracheal injuries, vocal cord injuries, sore throat and hoarseness are common complications of double-lumen tube (DLT) intubation.
OBJECTIVE
OBJECTIVE
This study aimed to evaluate the effects of 'video double-lumen tubes' (VDLTs) on intubation complications in patients undergoing thoracic surgery.
DESIGN
METHODS
A randomised controlled study.
SETTINGT
METHODS
Xuzhou Cancer Hospital, Xuzhou, China, from January 2023 to June 2023.
PATIENTS
METHODS
One hundred eighty-two patients undergoing elective thoracic surgery with one-lung ventilation were randomised into two groups: 90 in the DLT group and 92 in the VDLT group.
INTERVENTION
METHODS
VDLT was selected for intubation in the VDLT group, and DLT was selected for intubation in the DLT group. A fibreoptic bronchoscope (FOB) was used to record tracheal and vocal cord injuries.
MAIN OUTCOME MEASURES
METHODS
The primary outcomes were the incidence of moderate-to-severe tracheal injury and the incidence of vocal cord injury. The secondary outcomes included the incidence and severity of postoperative 24 and 48 h sore throat and hoarseness.
RESULTS
RESULTS
The incidence of moderate-to-severe tracheal injury was 32/90 (35.6%) in the DLT group, and 45/92 (48.9%) in the VDLT group ( P = 0.077; relative risk 1.38, 95% CI, 0.97 to 1.95). The incidence of vocal cord injury was 31/90 (34.4%) and 34/92 (37%) in the DLT and VDLT groups, respectively ( P = 0.449). The incidence of postoperative 24 h sore throat and hoarseness was significantly higher in the VDLT group than in the DLT group (for sore throat: P = 0.032, relative risk 1.63, 95% CI, 1.03 to 2.57; for hoarseness: P = 0.018, relative risk 1.48, 95% CI, 1.06 to 2.06).
CONCLUSION
CONCLUSIONS
There was no statistically significant difference in the incidence of moderate-to-severe tracheal injury and vocal cord injury between DLTs and VDLTs. While improving the first-attempt success rate, intubation with VDLT increased the incidence of postoperative 24 h sore throat and hoarseness.
TRIAL REGISTRATION
BACKGROUND
Chinese Clinical Trial Registry identifier: ChiCTR2300067348.
Identifiants
pubmed: 38298060
doi: 10.1097/EJA.0000000000001959
pii: 00003643-202404000-00007
pmc: PMC10906194
doi:
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
305-313Informations de copyright
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.
Références
Jenkins K, Grady D, Wong J, et al. Postoperative recovery: day surgery patients’ preferences. Br J Anaesth 2001; 86:272–274.
Christensen AM, Willemoes-Larsen H, Lundby L, et al. Postoperative throat complaints after tracheal intubation. Br J Anaesth 1994; 73:786–787.
Seo JH, Kwon TK, Jeon Y, et al. Comparison of techniques for double-lumen endobronchial intubation: 90° or 180° rotation during advancement through the glottis. Br J Anaesth 2013; 111:812–817.
Seo JH, Cho CW, Hong DM, et al. The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: a prospective double-blind randomized trial. Br J Anaesth 2016; 116:282–288.
Knoll H, Ziegeler S, Schreiber JU, et al. Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial. Anesthesiology 2006; 105:471–477.
Mourisse J, Liesveld J, Verhagen A, et al. Efficiency, efficacy, and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation. Anesthesiology 2013; 118:550–561.
Ruetzler K, Grubhofer G, Schmid W, et al. Randomized clinical trial comparing double-lumen tube and EZ-blocker for single-lung ventilation. Br J Anaesth 2011; 106:896–902.
Park JW, Jo JH, Park JH, et al. Comparison of conventional and fibreoptic-guided advance of left-sided double-lumen tube during endobronchial intubation: a randomised controlled trial. Eur J Anaesthesiol 2020; 37:466–473.
Ouyang BY, Wen XH, Liang LX. Analysis of size selection of double-lumen endobronchial tube. Chin J Anesthesiol 2001; 21:366–367.
Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology 1998; 88:346–350.
Brodsky JB, Benumof JL, Ehrenwerth J, et al. Depth of placement of left double-lumen endobronchial tubes. Anesth Analg 1991; 73:570–572.
Bahk JH. Guidelines for determining the appropriateness of double-lumen endobronchial tube size. Anesth Analg 2002; 95:501.
Schellhase DE, Graham LM, Fix EJ, et al. Diagnosis of tracheal injury in mechanically ventilated premature infants by flexible bronchoscopy. A pilot study. Chest 1990; 98:1219–1225.
Torda TA, Pybus DA. Extradural administration of morphine and bupivacaine. A controlled comparison. Br J Anaesth 1984; 56:141–146.
Krishna SG, Syed F, Hakim M, et al. A comparison of supraglottic devices in pediatric patients. Med Devices (Auckl) 2018; 11:361–365.
Heir JS, Guo SL, Purugganan R, et al. A randomized controlled study of the use of video double-lumen endobronchial tubes versus double-lumen endobronchial tubes in thoracic surgery. J Cardiothorac Vasc Anesth 2018; 32:267–274.
Schuepbach R, Grande B, Camen G, et al. Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial. Can J Anaesth 2015; 62:762–769.
Ruetzler K, Grubhofer G, Schmid W, et al. Randomized clinical trial comparing double-lumen tube and EZ-Blocker for singlelung ventilation. Br J Anaesth 2011; 106:896–902.
Ruetzler K, Fleck M, Nabecker S, et al. A randomized, doubleblind comparison of licorice versus sugar-water gargle for prevention of postoperative sore throat and postextubation coughing. Anesth Analg 2013; 117:614–621.
Onifade A, Lemon-Riggs D, Smith A, et al. Comparing the rate of fiberoptic bronchoscopy use with a video double lumen tube versus a conventional double lumen tube-a randomized controlled trial. J Thorac Dis 2020; 12:6533–6541.
Levy-Faber D, Malyanker Y, Nir RR, et al. Comparison of VivaSight double-lumen tube with a conventional doublelumen tube in adult patients undergoing video-assisted thoracoscopic surgery. Anaesthesia 2015; 70:1259–1263.
Palaczynski P, Misiolek H, Bialka S, et al. A randomized comparison between the VivaSight double-lumen tube and standard double-lumen tube intubation in thoracic surgery patients. J Thorac Dis 2022; 14:3903–3914.
Hegland N, Schnitzler S, Ellensohn J, et al. Dimensional variations of left-sided double-lumen endobronchial tubes. Anesthesiol Res Pract 2019; 2019:3634202.