Lung isolation with a bronchial blocker placed in the lateral position for patients undergoing thoracic surgery: A multicenter, randomized clinical trial.
Summary
In this multicenter randomized trial (n=306), placing a bronchial blocker directly in the lateral decubitus position reduced malposition from 25.3% to 0.7%, lowered repositioning needs, and decreased postural injuries without prolonging intubation time. Patient and surgeon satisfaction were higher with lateral placement.
Key Findings
- Malposition incidence: 0.7% (lateral) vs 25.3% (supine), P<0.001
- Fewer repositioning maneuvers in the lateral group (median 0 vs 1, P<0.001)
- Lower incidence of postural injury with lateral placement (P<0.001)
- Intubation duration similar between groups (P=0.089)
- Higher patient and surgeon satisfaction with lateral placement (both P<0.001)
Clinical Implications
Adopting lateral-position bronchial blocker placement can reduce intraoperative malposition, re-fiberoptic adjustments, and posture-related complications, potentially improving oxygenation stability and surgical efficiency.
Why It Matters
The magnitude of malposition reduction is large and directly addresses a common intraoperative problem in thoracic anesthesia. The findings are immediately implementable and likely to change standard placement workflows.
Limitations
- Lack of blinding may introduce performance bias
- Conducted in a single country; generalizability to different practice settings requires validation
Future Directions
Evaluate cost-effectiveness, training protocols, and applicability across various bronchial blocker types and double-lumen tubes; assess impact on intraoperative gas exchange and postoperative outcomes.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Multicenter randomized clinical trial with predefined primary endpoint
- Study Design
- OTHER