Hypoxemia in Thoracoscopic Lung Resection Surgery Using a Video Double-lumen Tube Versus a Conventional Double-lumen Tube: A Propensity Score-matched Analysis

Overview

Journal Front Surg

Specialty General Surgery

Date 2023 Mar 6

PMID 36874459

Authors

Wei Wang

Zhihao Gong

Mingye Zhao

Zuojing Zhang

Yuwei Qiu

Qiliang Jiang

Jingxiang Wu

Affiliations

Soon will be listed here.

Abstract

Background: Malposition of the double-lumen tubes (DLTs) may lead to hypoxemia during one-lung ventilation (OLV). Video double-lumen tubes (VDLTs) enable continuous observation of DLT position and avoid displacement. We aimed to investigate whether VDLTs could reduce the incidence of hypoxemia during OLV compared with conventional double-lumen tubes (cDLT) in thoracoscopic lung resection surgery.

Methods: This was a retrospective cohort study. Adult patients who underwent elective thoracoscopic lung resection surgery and required VDLTs or cDLTs for OLV at Shanghai Chest Hospital from January 2019 to May 2021 were included. The primary outcome was the incidence of hypoxemia during OLV between VDLT and cDLT. Secondary outcomes included bronchoscopy use, the degree of PaO decline, and arterial blood gas indices.

Results: A total of 1,780 patients were finally analyzed in propensity score-matched cohorts (VDLT vs. cDLT 1:1 = 890). The incidence of hypoxemia decreased from 6.5% (58/890) in cDLT group to 3.6% (32/890) in VDLT group (Relative Risk [RR]: 1.812, 95% CI: 1.19-2.76, = 0.005). The use of bronchoscopy was reduced by 90% in VDLT group (VDLT 10.0% (89/890) vs. cDLT 100% (890/890), < 0.001). PaO after OLV was 221 [136.0-325.0] mmHg in cDLT group compared to 234 [159.7-336.2] mmHg in VDLT group, = 0.003. The percentage of PaO decline was 41.4 [15.4-61.9] % in cDLT group, while it was 37.7 [8.7-55.9] % in the VDLT group, < 0.001. In patients who suffered from hypoxemia, there were no significant differences in arterial blood gas indices or the percentage of PaO decline.

Conclusion: VDLTs reduce the incidence of hypoxemia and the use of bronchoscopy during OLV compared with cDLTs. VDLT may be a feasible option for thoracoscopic surgery.

Citing Articles

Disposcope endoscope guidance versus fiberoptic bronchoscopy guidance for double-lumen tube intubation in patients undergoing thoracic surgery: a randomized controlled non-inferiority trial.

Jiang W, Zhou X, Zeng X, Pang H, Zheng H, Peng S Sci Rep. 2025; 15(1):5476.

PMID: 39953079 PMC: 11829012. DOI: 10.1038/s41598-025-89945-7.

Clinical practice of one-lung ventilation in mainland China: a nationwide questionnaire survey.

Liu H, Lin Y, Li W, Yang H, Kang W, Guo P BMC Anesthesiol. 2025; 25(1):7.

PMID: 39773104 PMC: 11706103. DOI: 10.1186/s12871-024-02879-x.

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