The combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomized controlled trial

Abstract

Background: Accurate placement of the right-sided double-lumen tube (RDLT) is still challenging. This study aims to explore the feasibility and accuracy of a modified intubation strategy by using a combination of computed tomography measurements and flexible video bronchoscope guidance.Methods: 108 adults requiring an RDLT for lung isolation were randomly allocated to 2 groups. Conventional fiberoptic bronchoscopy-guided technique was used in the control group. The following specifications applied to the modification group. Firstly, the length of the right main bronchus (RMB-L) and the anteroposterior diameter of RMB were measured in preoperative spiral computed tomography to predict the side and size of the tube; Then, a depth marker was made on RUSCH tube according to the difference between the RMB-L and the length of bronchia cuff (12 mm); Under the guidance of flexible video bronchoscope, the depth marker should be paralleled with the tracheal carina, and a characteristic white line on the tube should be paralleled with the secondary carina.Results: Compared with the control group, our modified strategy significantly increased the optimal plus acceptable position rate (76% vs. 98%, respectively; P < 0.039), decreased tube replacement rate (80% vs. 94%; P = 0.042), shortened the intubation time (101.4 ± 7.3 vs. 75.2 ± 8.1 seconds; P = 0.019), and had a lower incidence of transient hypoxemia (25% vs. 6%; P = 0.022), subglottic resistance (20% vs. 6%; P = 0.037), tracheobronchial injury (35% vs. 13; P = 0.037), and postoperative right upper lobe collapse (15% vs. 2%; P = 0.059).Conclusion: These data suggest the superiority of our modified technique compared to the conventional method for RDLT positioning.Trial registration: Chinese Clinical Trial Registry, ChiCTR1900021676, registered on 5 March 2019. URL of trial registry: http://www.chictr.org.cn/showprojen.aspx?proj=33189