Videolaryngoscopy versus direct laryngoscopy for double-lumen endotracheal tube intubation in thoracic surgery - a randomised controlled clinical trial

Abstract

Background: Double-lumen tube (DLT) intubation is necessary for thoracic surgery and other operations with the need for lung separation. However, DLT insertion is complex and might result in airway trauma. A new videolaryngoscopy (GVL) with a thin blade might improve the intubation time and reduce complexity as well as iatrogenic airway complications compared to conventional direct laryngoscopy (DL) for DLT intubation. Methods: A randomised, controlled trial was conducted in 70 patients undergoing elective thoracic surgery using DLT for lung separation. Primary endpoint was time to successful intubation. The secondary endpoints of this study were number of intubation attempts, the assessment of difficulty, any complications during DLT intubation and the incidence of objective trauma of the oropharynx and supraglottic space and intubation-related subjective symptoms. Results: 65 patients were included (DL group [n = 31], GVL group [n = 34]). Median intubation time (25th-75th percentiles) in GVL group was 93 s (63-160) versus 74 (58-94) in DL group [p = 0.044]. GVL resulted in significantly improved visualisation of the larynx (Cormack and Lehane grade of 1 in GVL group was 97% vs. 74% in DL Group [p = 0.008]). Endoscopic examinations revealed significant differences in GVL group compared to DL group showing less red-blooded vocal cord [p = 0.004], vocal cord haematoma [p = 0.022] and vocal cord haemorrhage [p = 0.002]. No significant differences regarding the postoperative subjective symptoms of airway were found. Conclusions: Videolaryngoscopy using the GlideScope®-Titanium shortly prolongs DLT intubation duration compared to direct laryngoscopy but improves the view. Objective intubation trauma but not subjective complaints are reduced.

Different classes of videoscopes and direct laryngoscopes for double-lumen tube intubation in thoracic surgery: A systematic review and network meta-analysis

“…Four groups of devices from 14 studies were available for the analysis [ 7 , 18 , 20 , 25 , 27 – 30 , 32 , 33 , 35 , 37 – 39 ]. Eligible comparisons in the NMA are shown in Figs 3D and 4D .…”

“…Success rate of the first attempt intubation of DLT. Four groups of devices from 21 studies were available for the analysis [1,7,8,17,18,20,[24][25][26][27][28][29][30][31][32][33][35][36][37][38][39]. Eligible comparisons in the NMA are shown in Figs 3A and 4A.…”

Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis

“…Then, the full texts were reviewed, and 32 studies were excluded because they did not involve Macintosh direct laryngoscope as a comparator group, consisted of manikin trials, involved different interventions, or were reviews or meta-analyses. Ultimately, 25 studies [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] published in the period of 2010–2021 were included in this meta-analysis.…”

Comparison of left double lumen tube and y-shaped and double-ended bronchial blocker for one lung ventilation in thoracic surgery—a randomised controlled clinical trial

“…This study was performed in compliance with recognised international standards, including the principles of the Declaration of Helsinki. This study uses established methodology from a previously published work of our Airway Research Group with the focus on thoracic anesthesia; therefore there are similarities and overlaps in the methodology [ 18 ]. After providing written informed consent, adult patients scheduled for elective thoracic surgery requiring general anesthesia with the need for one lung ventilation with American Society of Anaesthesiologists physical status I-IV were enrolled from 11.06.2018 until 14.02.2020.…”