Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial
Objective To compare the modified strategy for the right-sided double-lumen tube (R-DLT) placement using a combination of CT measurements and flexible video bronchoscopy guidance with traditional bronchoscopy technique.Trial design, setting and participants Double-blind, parallel randomised control...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/11/e066541.full |
| _version_ | 1797435562492166144 |
|---|---|
| author | Yuanyuan Zhang Jian Li Mingzhu Xu Yishan Lei Yingcong Qian Wenwen Huo Qiuyuan Ji Jianping Yang Huayue Liu Yongheng Hou |
| author_facet | Yuanyuan Zhang Jian Li Mingzhu Xu Yishan Lei Yingcong Qian Wenwen Huo Qiuyuan Ji Jianping Yang Huayue Liu Yongheng Hou |
| author_sort | Yuanyuan Zhang |
| collection | DOAJ |
| description | Objective To compare the modified strategy for the right-sided double-lumen tube (R-DLT) placement using a combination of CT measurements and flexible video bronchoscopy guidance with traditional bronchoscopy technique.Trial design, setting and participants Double-blind, parallel randomised control trial at a tertiary care medical centre in China. 100 patients undergoing video-assisted thoracoscopic surgery and requiring R-DLT were randomly allocated to the control group and the intervention group.Intervention The control group used the traditional bronchoscopy-guided technique. In the intervention group, the length and anteroposterior diameter of the right main bronchus (RMB) were measured on CT images to select the side and size of the Rüsch tube, and then a black depth marker was placed on the tube according to the difference between the length of the RMB and the bronchial cuff. Under the guidance of bronchoscopy, the depth marker should be placed parallel to the tracheal carina and a characteristic white line on the tube should be parallel to the midline of the tracheal carina.Main outcomes The primary endpoint was the positioning of right upper lobe (RUL) ventilatory slot and RUL bronchial orifice. The secondary endpoints included intubation data and perioperative adverse events.Results Compared with the control group, our modified strategy significantly increased the optimal and acceptable position rate (76% vs 98%, respectively; p<0.039), decreased the replacement rate (80% vs 94%; p=0.042), shortened the intubation time (101.4±7.3 s vs 75.2±8.1 s; p=0.019) and reduced the incidence of transient hypoxaemia (25% vs 6%; p=0.022), subglottic resistance (20% vs 6%; p=0.037), tracheobronchial injury (35% vs 13%; p=0.037) and postoperative RUL collapse (15% vs 2%; p=0.059).Conclusion This study demonstrates the superiority of our strategy and provides a new viable method for R-DLT placement.Trial registration number Chinese Clinical Trial Registry (ChiCTR1900021676). |
| first_indexed | 2024-03-09T10:48:54Z |
| format | Article |
| id | doaj.art-f683febcdd064cc59b18d605323d7921 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-09T10:48:54Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-f683febcdd064cc59b18d605323d79212023-12-01T09:40:08ZengBMJ Publishing GroupBMJ Open2044-60552023-11-01131110.1136/bmjopen-2022-066541Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trialYuanyuan Zhang0Jian Li1Mingzhu Xu2Yishan Lei3Yingcong Qian4Wenwen Huo5Qiuyuan Ji6Jianping Yang7Huayue Liu8Yongheng Hou9Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaObjective To compare the modified strategy for the right-sided double-lumen tube (R-DLT) placement using a combination of CT measurements and flexible video bronchoscopy guidance with traditional bronchoscopy technique.Trial design, setting and participants Double-blind, parallel randomised control trial at a tertiary care medical centre in China. 100 patients undergoing video-assisted thoracoscopic surgery and requiring R-DLT were randomly allocated to the control group and the intervention group.Intervention The control group used the traditional bronchoscopy-guided technique. In the intervention group, the length and anteroposterior diameter of the right main bronchus (RMB) were measured on CT images to select the side and size of the Rüsch tube, and then a black depth marker was placed on the tube according to the difference between the length of the RMB and the bronchial cuff. Under the guidance of bronchoscopy, the depth marker should be placed parallel to the tracheal carina and a characteristic white line on the tube should be parallel to the midline of the tracheal carina.Main outcomes The primary endpoint was the positioning of right upper lobe (RUL) ventilatory slot and RUL bronchial orifice. The secondary endpoints included intubation data and perioperative adverse events.Results Compared with the control group, our modified strategy significantly increased the optimal and acceptable position rate (76% vs 98%, respectively; p<0.039), decreased the replacement rate (80% vs 94%; p=0.042), shortened the intubation time (101.4±7.3 s vs 75.2±8.1 s; p=0.019) and reduced the incidence of transient hypoxaemia (25% vs 6%; p=0.022), subglottic resistance (20% vs 6%; p=0.037), tracheobronchial injury (35% vs 13%; p=0.037) and postoperative RUL collapse (15% vs 2%; p=0.059).Conclusion This study demonstrates the superiority of our strategy and provides a new viable method for R-DLT placement.Trial registration number Chinese Clinical Trial Registry (ChiCTR1900021676).https://bmjopen.bmj.com/content/13/11/e066541.full |
| spellingShingle | Yuanyuan Zhang Jian Li Mingzhu Xu Yishan Lei Yingcong Qian Wenwen Huo Qiuyuan Ji Jianping Yang Huayue Liu Yongheng Hou Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial BMJ Open |
| title | Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial |
| title_full | Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial |
| title_fullStr | Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial |
| title_full_unstemmed | Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial |
| title_short | Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial |
| title_sort | combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right sided double lumen tube a randomised controlled trial |
| url | https://bmjopen.bmj.com/content/13/11/e066541.full |
| work_keys_str_mv | AT yuanyuanzhang combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT jianli combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT mingzhuxu combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT yishanlei combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT yingcongqian combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT wenwenhuo combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT qiuyuanji combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT jianpingyang combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT huayueliu combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial AT yonghenghou combinationofcomputedtomographymeasurementsandflexiblevideobronchoscopeguidanceforaccurateplacementoftherightsideddoublelumentubearandomisedcontrolledtrial |