Ultrasound-guided double-lumen tube size selection improves intubation success and postoperative airway outcomes in thoracic surgery: a randomized controlled study.

BACKGROUND

Appropriate double-lumen tube (DLT) size selection is crucial for safe and effective one-lung ventilation in thoracic surgery. Conventional selection based on sex and height does not account for individual airway variability. This study evaluated whether ultrasound-guided DLT size selection improves intubation success and postoperative airway outcomes.

METHODS

In this prospective randomized controlled study, 70 patients undergoing thoracic surgery who required one-lung ventilation were assigned to either a conventional group (DLT size based on sex and height) or an ultrasound group (DLT size based on tracheal diameter measured by ultrasound at the suprasternal notch). The primary outcome was the incidence of postoperative sore throat at 24 h. Secondary outcomes included postoperative cough, first-attempt intubation success, number of attempts, surgeon-rated lung collapse satisfaction, and intraoperative respiratory parameters.

RESULTS

Postoperative sore throat was significantly lower in the ultrasound group compared to the conventional group (8.6% vs. 37.1%, p = 0.004). Postoperative cough was also reduced (8.6% vs. 40.0%, p = 0.002). First-attempt intubation success was higher in the ultrasound group (97.1% vs. 62.9%, p = 0.001). Additionally, peak airway pressure was lower, and dynamic compliance was higher in the ultrasound group (p = 0.002 and p < 0.001, respectively). Surgeon satisfaction was significantly improved (p = 0.005).

CONCLUSION

Ultrasound-guided DLT size selection improves intubation success, reduces postoperative airway complications, and enhances ventilatory parameters. This approach may provide a simple and effective method for optimizing airway management in thoracic surgery.