Videolaryngoscopy versus direct laryngoscopy for double-lumen tube intubation: the DOuble-Lumen intubation with VIdeolaryngoscopy (DOLVI) multicentre randomised trial.

BACKGROUND

Although videolaryngoscopy has shown benefits over direct laryngoscopy for tracheal intubation with single-lumen tubes, its role in double-lumen tube placement remains unclear.

METHODS

In this multicentre, randomised trial conducted in four Spanish hospitals, we assigned adults undergoing surgery requiring lung isolation to receive double-lumen tube intubation with either videolaryngoscopy or direct laryngoscopy. The primary outcome was successful intubation on the first attempt. Secondary outcomes included glottic visualisation, ease of intubation, external airway manipulation, oesophageal intubation, double-lumen tube malposition, and other peri-intubation complications.

RESULTS

Among the 916 patients enrolled, successful first-attempt intubation occurred in 388 of 458 (84.7%) participants in the videolaryngoscopy group and 352 of 458 (76.9%) in the direct laryngoscopy group (absolute risk difference 7.9 percentage points; 95% confidence interval [CI] 2.8-12.8; P=0.003). A total of 429 participants (93.7%) in the videolaryngoscopy group and 370 (80.8%) in the direct laryngoscopy group had good glottic visualisation (absolute risk difference 12.9%; 95% CI 8.6%-17.1%; P<0.001). Videolaryngoscopy was associated with a higher rate of easy intubation (81.9% vs 68.6%; absolute risk difference, 13.3%; 95% CI 7.8%-18.8%; P<0.001) and reduced external airway manipulation (28.6% vs 40.6%; P<0.001), loss of glottic view (4.4% vs 21.8%; P<0.001), oesophageal intubation (1.7% vs 4.6%; P=0.014), and double-lumen tube malposition (7.6% vs 12.4%; P=0.016). Intubation time and other complications were similar between groups.

CONCLUSIONS

Among patients undergoing surgery requiring lung isolation, videolaryngoscopy increased first-attempt success and improved glottic visualisation while reducing procedural difficulty in double-lumen tube placement compared with direct laryngoscopy.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT06401486.