Bronchial Blockers versus Double-Lumen Endotracheal Tubes: Impact on Postoperative Pneumonia in Lung Cancer Patients Undergoing Video-Assisted Thoracoscopic Surgery - A Propensity Score-Matched Study.

Abstract

Purpose: To compare the differential effects of bronchial blockers (BBs) versus double-lumen endotracheal tubes (DLETs) on postoperative pulmonary complications (PPCs) in patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer.

Patients and methods: This retrospective cohort study analyzed patients undergoing VATS requiring one-lung ventilation under general anesthesia from April 2023 to August 2024. Lung isolation was achieved using either BBs with single-lumen endotracheal tubes or DLETs. Propensity score matching was implemented to mitigate differences in patients' baseline characteristics. The primary outcome was the incidence of PPCs during hospitalization.

Results: Propensity score matching resulted in 152 matched pairs of patients in the BB and DLET groups. The incidence rates of PPCs (6.6% vs 16.4%; P = 0.007) and pneumonia (3.9% vs 11.8%; P = 0.011) during hospitalization were significantly lower in the BB group than in the DLET group. Average oxygen saturation (P = 0.024), end-tidal carbon dioxide (P = 0.009), fraction of inspired oxygen (P = 0.010), and respiratory rate (P < 0.001) were significantly higher in the BB group. Mechanical ventilation parameters, including average peak airway pressure (P < 0.001), mean airway pressure (P < 0.001), and tidal volume (P = 0.003), were significantly lower in the BB group.

Conclusion: Compared with patients intubated using a DLET, patients with lung cancer undergoing VATS and intubated using a BB experienced a lower incidence of PPCs.