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The goal of this clinical trial is to assess the incidence of double-lumen endobronchial tube displacement in patients undergoing thoracic surgery with a change in position, compared with double-lumen endobronchial tube malposition in chest surgery patients with a fixed breathing circuit. The study is to investigate: whether detaching the breathing circuit in patients undergoing thoracic surgery would reduce the rate of double-lumen endobronchial tube malposition, the incidence of postoperative pulmonary complications, and improve patient outcomes.
Participants will be randomly divided into a disconnected breathing circuit group and a breathing circuit connected group and after entering the operating room, the intravenous access will be opened, and blood pressure, heart rate, electrocardiogram, oxygen saturation, arterial pressure, and end-expiratory carbon dioxide will be monitored. Anesthesia induction will be performed by an anesthesiologist, and then the double-lumen endobronchial tube will be inserted under laryngoscopic guidance. Will the catheter be delivered to the expected depth, the double-lumen endobronchial tube will be connected to the anesthesia machine for mechanical ventilation.
Researchers will compare the malposition rate of the double-lumen endobronchial tube when the patient transitions from the supine to lateral decubitus position, the effect of single-lung ventilation, oxygen saturation at 5 and 10 minutes after single-lung ventilation, and postoperative recovery time.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Disengagement of the breathing circuit | Experimental | When the patient's position is changed from the supine position to the lateral decubitus position, the anesthesiologist disengages the breathing circuit. |
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| Connect the breathing circuit | No Intervention | When the patient's position is changed from the supine position to the lateral decubitus position, the anesthesiologist maintains the normal connection of the breathing line. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Disengage the breathing circuit | Behavioral | Disengage the breathing circuit when the position of the patient undergoing thoracic surgery changes |
|
| Measure | Description | Time Frame |
|---|---|---|
| Malposition rate of a double-lumen endobronchial tube | Double-lumen endobronchial tube malposition is more than 5 mm away from the optimal position of the catheter. Severe malposition is the inability to see the upper left or lower left bronchial opening in the left common bronchi: the right upper lobe bronchial opening cannot be seen clearly in the right common bronchi; or bronchial cuffs more than 50% in the trachea. | Immediately after a change in body position |
| Measure | Description | Time Frame |
|---|---|---|
| Effects of lung collapse | If the lung on the operative side is completely atrophied and the surgical field is satisfied, it indicates that the degree of lung atrophy is good. The surgeon will score the quality of lung collapse using a four-point ordinal scale (1= extremelypoor-no collapse of lung; 2= poor-partial collapse of lung with interference with surgical exposure; 3= good-total collapse, but the lung still had some residual air; and 4= excellent-complete collapse of lung with perfect surgical exposure). |
| Measure | Description | Time Frame |
|---|---|---|
| Partial pressure of carbon dioxide at the end of expiration | Determine the status of blood-lung ventilation and pulmonary blood flow | 1 minute and 5 minutes after the change of position；1 minute, 5 minutes and 10 minutes after single-lung ventilation |
| Blood pressure |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jin Bao Mao, Ph.D. | Shandong Provincial Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shandong Provincial Hospital Affiliated to Shandong First Medical University | Jinan | S | 250021 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41761244 | Derived | Lv S, Lv M, Du W, Zou Z, Zheng K, Qu J, Han X, Mao J. Does ventilator circuit disconnection during lateral positioning reduces the rate of double-lumen endotracheal tube displacement in thoracic surgery? a study protocol for a randomized controlled trial. Trials. 2026 Feb 28;27(1):272. doi: 10.1186/s13063-026-09567-w. |
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Intervention: After the insertion of a DLT under general anesthesia, the anesthesiologist disengaged the breathing circuit when the patient transitioned from the supine to the lateral position.
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As this research uses a behavioral intervention, it will conceal the grouping from the subjects. Random numbers will be placed in opaque envelopes by independent persons not involved in this experiment to achieve allocation concealment.
| 5 and 10 minutes after the pleura opens |
| Blood oxygen saturation | An oxygen saturation below 94% is considered oxygen insufficiency | 1 minute and 5 minutes after the change of position；1 minute, 5 minutes and 10 minutes after single-lung ventilation |
| PACU length of stay | The patient is awake and conscious | The time from the transfer to the PACU to the transfer out to ward, an average of an hour |
Make sure the patient's blood pressure is within the normal range |
| 1 minute and 5 minutes after the change of position；1 minute, 5 minutes and 10 minutes after single-lung ventilation |
| Heart rate | Make sure the patient's heart rate is within the normal range | 1 minute and 5 minutes after the change of position；1 minute, 5 minutes and 10 minutes after single-lung ventilation |