Right lateral decubitus as a strategy to improve left bronchial blocker placement in thoracic operations: a randomized clinical trial.

BACKGROUND

Left-sided bronchial blocker (BB) placement can sometimes be challenging and time-consuming, often requiring multiple fiberoptic bronchoscopic examinations. This study evaluated whether right lateral decubitus positioning improves placement compared to the supine position.

METHODS

In this prospective, single-center randomized controlled trial, 90 adult patients scheduled for elective thoracic surgery with right one-lung ventilation were randomized to receive BB placement in either the right lateral decubitus or supine position. The primary outcome was ease of placement, defined as first-attempt success or successful placement under bronchoscopic guidance within 120 s. Secondary outcomes included placement time, malposition rate, intraoperative hemodynamic and blood gas changes, and postoperative recovery. Additionally, nine patients had chest CT scans in both positions to assess tracheobronchial alignment.

RESULTS

Right lateral positioning significantly improved placement compared to supine, with higher ease of placement (87% vs. 27%), greater first-attempt success (29% vs. 11%), shorter median time to placement (97 s vs. 201 s), and lower malposition rate (11% vs. 29%). In the supine group, all patients required bronchoscopic verification after lateral repositioning, and 11.1% needed repositioning; no additional verification was needed in the lateral group. CT analysis revealed that right lateral positioning increased the left main bronchus angle (148.3°vs 142.9°), aligning the BB more directly with the opening of the left main bronchus.

CONCLUSIONS

Right lateral decubitus enhances left BB placement by increasing first-attempt success, reducing procedural time, and decreasing malposition. CT imaging confirms anatomical realignment facilitating insertion.