Universal videolaryngoscopy for double-lumen tube tracheal intubation: subanalysis of the VIDEOLAR-SURGERY trial

Abstract

[Abstract] Background: Double-lumen endotracheal tube (DLT) is technically challenging and associated with higher rates of difficult intubation compared to single-lumen tubes. This post hoc analysis of the VIDEOLAR-SURGERY trial aimed to assess whether the universal use of a videolaryngoscope improves the rate of easy intubation in patients requiring DLT placement.

Methods: We conducted a post hoc subanalysis of a prospective, multicenter, before-and-after study involving 5135 surgical patients. In the non-interventional phase (June-December 2023), DLT intubations were performed using direct laryngoscopy as the first-choice technique. In the interventional phase (February-September 2024), a Macintosh-type videolaryngoscope was used as the first-choice device. The primary outcome was the rate of easy intubation, defined as first-attempt success, a modified Cormack-Lehane grade I or IIa glottic view, and no need for adjuvant airway devices. Secondary outcomes included glottic visualization, perceived technical difficulty, and complications.

Results: A total of 189 patients were included, 95 in the non-interventional phase and 94 in the interventional phase. The rate of easy intubation was significantly higher with videolaryngoscopy (91.5%) compared with direct laryngoscopy (76.8%) (absolute risk difference 14.6%; 95% CI, 4.5%-24.8%). First-attempt success was also higher with videolaryngoscopy (94.7% vs. 82.1%; absolute risk difference 12.6%; 98.3% CI, 2.9%-22.3%). The interventional phase was also associated with a trend toward improved glottic visualization (94.7% vs. 87.4%), lower perceived technical difficulty, and fewer complications.

Conclusion: Universal videolaryngoscopy improved glottic visualization and the rate of easy double lumen tube intubation compared with direct laryngoscopy, while reducing technical difficulty and complications.