Double-lumen tubes verus single-lumen tube in patients undergoing minimally invasive cardiac surgery: a randomised, controlled clinical trial

TL;DR

Using a single-lumen tube instead of a double-lumen tube during minimally invasive heart surgery improves oxygen levels and reduces complications.

Contribution

This study provides clinical evidence that single-lumen tubes are superior to double-lumen tubes in specific cardiac surgeries.

Findings

The SLT group had significantly better oxygenation (PaO2/FiO2) than the DLT group.

The SLT group experienced fewer postoperative complications like pulmonary atelectasis and hoarseness.

SLT use resulted in shorter pre-exposure and intubation times.

Abstract

One-lung ventilation (OLV) with double-lumen tubes (DLT) are prone to complications such as airway injury and hypoxemia. It is not clear whether a two-lung ventilation (TLV) with single-lumen tube (SLT) is beneficial for patients undergoing totally endoscopic cardiac valve surgery (TECVS).

We conducted a pragmatic, single-centre, single-blinded randomised controlled trial. Patients (aged ≥18 years) who underwent total endoscopic cardiac valve surgery were randomly assigned to a DLT group or a SLT group. A two-week telephone follow-up was conducted. The oxygenation index (PaO2/FiO2) was the primary outcome. The secondary outcomes included PaCO2, postoperative intubation complications, postoperative pulmonary complications and airway injury.

A total of 220 patients were randomly assigned. After randomisation, 20 patients were excluded, leaving 100 patients in each of the two groups. The PaO2/FiO2 were significantly greater in the SLT group than in the DLT group (P < 0.001). The incidence of postoperative intubation adverse events, postoperative pulmonary atelectasis, and hoarseness was significantly lower in the SLT group (P < 0.001, P = 0.029 and P = 0.028, respectively). The pre-exposure time and intubation time were shorter in the SLT group (both P values < 0.001). We used t test, Mann-Whitney U test and Fisher's exact test to account the difference of perioperative and follow-up outcomes.

Two-lung ventilation with single-lumen tube is easy to perform, significantly increases oxygenation, and decreases the incidence of postoperative complications and airway injuries. Advantages remain especially for patients with preoperative pulmonary dysfunction.

https://www.chictr.org.cn/showproj.html?proj=165709, identifier [ChiCTR2200066822]. Date: 19/12/2022.

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