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Background&#xa0;and objectives <p>Minimally invasive coronary artery bypass grafting (MIDCAB) requires effective left lung isolation, yet evidence comparing video-imaging single-lumen tracheal tubes with bronchial blockers (VSLT + BB) and video-imaging double-lumen endotracheal tubes (VDLT) remains limited. This randomized controlled trial aimed to: (1) quantitatively compare time efficiency for device placement and lung isolation between VSLT + BB and VDLT; (2) evaluate perioperative airway complications; and (3) assess differential impacts on postoperative recovery, including postoperative sore throat, hoarseness, and Quality of Recovery-15 (QoR-15) scores.</p> Methods <p>In this single-blind randomized controlled trial, 97 MIDCAB patients were allocated to VSLT + BB or VDLT groups. Primary outcomes were tube positioning time; secondary outcomes included total intubation time, oxygenation parameters, hemodynamic variables, and postoperative complications.</p> Results <p>VDLT exhibited shorter tube positioning time (128 ± 37 vs. 159 ± 58&#xa0;s; <i>p</i> &lt; 0.001) but longer total intubation time (192 ± 40 vs. 159 ± 58&#xa0;s; <i>p</i> &lt; 0.001). VSLT + BB demonstrated higher PaO₂ at 10-min post-OLV (226.0 vs. 168.0 mmHg; <i>p</i> = 0.035) with lower airway pressures (<i>p</i> &lt; 0.05). Postoperative sore throat (33% vs. 13%; OR 2.84, 95% CI 1.04, 7.71; <i>p</i> = 0.018) and hoarseness at 48&#xa0;h (55% vs. 31%; OR 2.45, 95% CI 1.08, 5.59; <i>p</i> = 0.018) were higher with VDLT. Lung collapse quality, hypoxemia rates, pulmonary complications, and QoR-15 scores showed no significant differences (all <i>p</i> &gt; 0.05).</p> Conclusions <p>In MIDCAB surgery, VDLT demonstrated significantly shorter tube positioning time compared with VSLT + BB. However, VSLT + BB exhibited shorter total intubation time than VDLT by avoiding postoperative tube exchange. Both techniques provided clinically acceptable lung isolation with comparable lung collapse quality and hypoxemia incidence. VSLT + BB exhibited lower airway pressures and higher oxygenation indices during early OLV, whereas VDLT was associated with higher rates of minor airway complications (sore throat, hoarseness). No significant differences were observed in pulmonary complications, hemodynamic stability, or recovery quality.</p> Trial registration <p>ChiCTR2300072124, 3/6/2023.</p>

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A randomised controlled trial comparing of the efficacy and safety of left lung isolation for minimally invasive direct coronary artery surgery using video-imaging double-lumen endobronchial tube with a bronchial blocker paced through a video-imaging single-lumen tracheal tube

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  • 出版模式：

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  • 发表日期：

    2025年12月26日

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  • Yinglun Fang,
  • Mingya Wang,
  • Taotao Liu,
  • Pengyang Han,
  • Meiyu Zhao,
  • Ying Deng,
  • Chengmei Shi,
  • Bin Han,
  • Jing Zhang,
  • Min Li,
  • Yunpeng Ling,
  • Xiangyang Guo,
  • Yang Zhou,
  • Yongzheng Han

摘要

Background and objectives

Minimally invasive coronary artery bypass grafting (MIDCAB) requires effective left lung isolation, yet evidence comparing video-imaging single-lumen tracheal tubes with bronchial blockers (VSLT + BB) and video-imaging double-lumen endotracheal tubes (VDLT) remains limited. This randomized controlled trial aimed to: (1) quantitatively compare time efficiency for device placement and lung isolation between VSLT + BB and VDLT; (2) evaluate perioperative airway complications; and (3) assess differential impacts on postoperative recovery, including postoperative sore throat, hoarseness, and Quality of Recovery-15 (QoR-15) scores.

Methods

In this single-blind randomized controlled trial, 97 MIDCAB patients were allocated to VSLT + BB or VDLT groups. Primary outcomes were tube positioning time; secondary outcomes included total intubation time, oxygenation parameters, hemodynamic variables, and postoperative complications.

Results

VDLT exhibited shorter tube positioning time (128 ± 37 vs. 159 ± 58 s; p < 0.001) but longer total intubation time (192 ± 40 vs. 159 ± 58 s; p < 0.001). VSLT + BB demonstrated higher PaO₂ at 10-min post-OLV (226.0 vs. 168.0 mmHg; p = 0.035) with lower airway pressures (p < 0.05). Postoperative sore throat (33% vs. 13%; OR 2.84, 95% CI 1.04, 7.71; p = 0.018) and hoarseness at 48 h (55% vs. 31%; OR 2.45, 95% CI 1.08, 5.59; p = 0.018) were higher with VDLT. Lung collapse quality, hypoxemia rates, pulmonary complications, and QoR-15 scores showed no significant differences (all p > 0.05).

Conclusions

In MIDCAB surgery, VDLT demonstrated significantly shorter tube positioning time compared with VSLT + BB. However, VSLT + BB exhibited shorter total intubation time than VDLT by avoiding postoperative tube exchange. Both techniques provided clinically acceptable lung isolation with comparable lung collapse quality and hypoxemia incidence. VSLT + BB exhibited lower airway pressures and higher oxygenation indices during early OLV, whereas VDLT was associated with higher rates of minor airway complications (sore throat, hoarseness). No significant differences were observed in pulmonary complications, hemodynamic stability, or recovery quality.

Trial registration

ChiCTR2300072124, 3/6/2023.