Comparison of the effects of video double-lumen endotracheal tubes and conventional double-lumen endotracheal tubes on peripheral oxygen saturation during one-lung ventilation in patients undergoing thoracoscopic surgery: a prospective randomized controlled trial

Abstract Background Compared to the conventional double-lumen endotracheal tube (c-DLT), the video double-lumen endotracheal tube (v-DLT) demonstrates a shorter intubation time and the capability of observing and adjusting malposition at any time. Our objective was to compare the incidence of hypoxemia during one-lung ventilation (OLV) and perioperative complications between the two tube types. Methods 100 patients undergoing video-assisted thoracic surgery (VATS) were randomized to receive either a v-DLT or a c-DLT. Low tidal volume ventilation was used during OLV. The primary outcome was the incidence of hypoxemia (defined as SpO₂<90%) during OLV. To prevent its occurrence, a predefined protocol was activated if SpO₂ dropped below 95%. Sequential interventions included DLT repositioning, increasing FiO₂, adjusting ventilator settings, applying 5 cmH₂O PEEP to the ventilated lung, applying 5 cmH₂O CPAP to the operative lung, or resuming two-lung ventilation. Results The incidence of hypoxemia during OLV in the v-DLT group was significantly lower than that in the c-DLT group (6.3% vs. 27.7%, p = 0.006). No statistically significant difference was observed in postoperative complications between two groups (p = 0.732). The v-DLT demonstrated greater convenience (p <0.001), shorter intubation time (p < 0.001), easier intubation (p < 0.001), higher intubation success rate (p < 0.001), lower workload (p < 0.001), higher work efficiency (p < 0.001), and could enhance user satisfaction among anesthesiologists (p < 0.001). Conclusions The v-DLT can significantly reduce the incidence of hypoxemia during OLV compared with the c-DLT. Simultaneously, it reduced the workload of anesthesiologists and enhanced their overall satisfaction levels. Trial registration: Chictr.org.cn ChiCTR2100046484. Registered on 16 May 2021.