The intubation of patients undergoing thoracic surgery can be a complex and challenging procedure, especially when it involves the use of double-lumen tubes (DLT). A recent study conducted at Deyang People’s Hospital has evaluated the efficacy of disposcope endoscope guidance against the established fiberoptic bronchoscopy (FOB) for this purpose, demonstrating promising results.
DLT intubation is often necessary for lung isolation during various thoracic surgical procedures. Traditional methods involving FOB have long been regarded as the gold standard due to their high success rates; nevertheless, they are not without their drawbacks. Instances of unavailability due to maintenance, costs, and unfamiliarity with equipment can hinder timely interventions. Recognizing these limitations, the researchers tested the disposcope endoscope as an alternative method, hypothesizing it could match or even exceed the success of the FOB technique.
Conducted between August 2023 and January 2024, the study involved 181 patients who required DLT intubation for elective thoracic surgery. The participants were randomly assigned to one of two groups: one receiving disposcope guidance (DE group) and the other receiving FOB guidance (FOB group). The primary outcome of interest was the first-attempt success rate for DLT placement, with secondary outcomes assessing intubation times and the number of attempts required.
Both techniques showed commendable success rates: the DE group achieved 91.3% on the first attempt, compared to 89.9% for the FOB group. Notably, this difference fell within the non-inferiority margin defined by the researchers, establishing disposcope as a viable alternative for DLT intubation.
Besides matching the success rates, the use of the disposcope endoscope revealed significant advantages. The first-attempt intubation time was considerably shorter for the DE group, clocking in at just 66 seconds compared to 77 seconds for the FOB group. This improvement can be attributed to the design of the disposcope, which reduces potential contamination of the lens during the procedure, thereby streamlining the intubation process.
Upon examining intraoperative parameters, including changes to mean arterial pressure and heart rate post-intubation, no significant differences were found between the two groups, indicating both methods are equally safe. Factors such as intraoperative dislodgement and postoperative complications like sore throat and hoarseness also showed no significant variance, highlighting the effectiveness of both approaches.
The results of this non-inferiority trial indicate not only the comparability of disposcope guidance to standard techniques but also its potential as the preferred method under certain clinical circumstances. For anesthetics, the disposcope provides real-time visualization, making the DLT placement easier and potentially reducing the operational time needed.
According to the authors of the article, "Disposcope endoscope guidance provided a non-inferior first-attempt success rate and a shorter first intubation time for DLT intubation." This study introduces fresh perspectives on DLT intubation techniques, poised to influence practices across hospitals adopting this technology.
Further research and larger-scale trials are necessary to validate these findings and establish generalizability across varying patient demographics and clinical settings. Nonetheless, the promising outcomes merit consideration of disposcope endoscope guidance as part of anesthesiologists’ toolkit for thoracic surgeries.
Considering the growing emphasis on efficient and effective airway management practices, the study advocates for the wider implementation of disposcope technology as it emerges as not only effective but also practical for real-world application. With promising success rates and shorter intubation times, disposcope could redefine standard practices for double-lumen tube intubation.