Comparison of SEEKflex and Stylet for double-lumen tube intubation: a multicenter randomized controlled trial

Background: Tracheal injury, vocal cord injury, sore throat, and hoarseness are common complications of double-lumen tube (DLT) intubation. We try to make efforts to minimize these complications. Our objective is to test whether the use of Safe Easy Endotracheal kit-flexible (SEEK flex )-assisted DLT intubation reduces complications. Methods: We conducted a multicenter, non-blinded, randomized, parallel-group clinical trial with the aim of comparing the use of SEEK flex versus Stylet in DLT intubation under videolaryngoscopy. Between January 2023 and May 2024, patients aged 18–75 years who required a left-sided DLT to maintain pulmonary isolation during thoracic surgery. We randomly assigned 140 patients to two groups in a 1:1 ratio: SEEK flex combined with videolaryngoscopy group (SEEK flex group) and Stylet combined with videolaryngoscopy group (Stylet group). Results: The incidence of sore throat and hoarseness at 24 h postoperatively was significantly higher in the Stylet group than in the SEEK flex group (sore throat, 33% vs 17%, P = 0.032, hoarseness, 41% vs 26%, P = 0.049); however, there was no significant difference in severity between the two groups. No patients developed new sore throat or hoarseness on postoperative day 2, and the incidence and severity of sore throat and hoarseness were similar between the two groups. The incidence of tracheal injury was higher in the Stylet group than in the SEEK flex group (24% vs 10%, P = 0.025). After examining all participants, 12 patients in the Stylet group and 4 patients in the SEEK flex group experienced vocal cord congestion or edema. The incidence of vocal cord injury was higher in the Stylet group compared to SEEK flex group (17% vs 6%, P = 0.034). Conclusions: SEEK flex -assisted DLT intubation reduces complications.