Efficiency and safety of double-lumen bronchial tube and bronchial blocker for one-lung ventilation in patients with thoracic surgery: a meta-analysis.

Objectives: To compare the efficiency and safety of double-lumen bronchial tube (DLBT) and bronchial blocker (BB) for one-lung ventilation (OLV) in patients with thoracic surgery.

Methods: A systematic search was conducted across Chinese databases and English databases from the inception of the databases until December 31, 2024. Two researchers independently screened the literature and extracted data. A meta-analysis was then performed using Review Manager 5 and Stata 18.0 software. The quality of the studies was assessed using the Cochrane bias risk assessment tool, and a summary of findings (SoF) table was generated using GRADEprofiler Version 3.6.1.

Results: A total of 39 RCTs were included, comprising 1360 patients in the BB group and 1349 patients in the DLBT group. The excellent rate of lung collapse quality in the BB group was 0.94 times that in the DLBT group [I² = 32%, P = 0.07, fixed-effects; RR = 0.94; 95% CI (0.90, 0.99); P = 0.01]. There was no significant difference in intubation time [I² = 97%, P < 0.00001; SMD = -0.51; 95% CI (-1.17, 0.14); P = 0.12], the success rate of first-attempt intubation [I² = 79%, P < 0.00001; RR = 1.04; 95% CI (0.93, 1.15); P = 0.51] or in the incidence of malposition[I² = 50%, P = 0.01; RR = 1.36; 95% CI (0.95, 1.96); P = 0.10)] between the two groups. However, there was a significant difference in positioning time, with the BB group showing shorter positioning times compared to the DLBT group [I² = 98%, P < 0.00001; SMD = -0.85; 95% CI (-1.50, -0.21); P = 0.004]. Compared to the DLBT group, the BB group was associated with a reduced incidence of hoarseness, sore throat, tracheal mucosal injury, hypoxemia, and pneumonia.

Conclusion: The DLBT group demonstrated certain advantages in terms of lung collapse time and quality of lung collapse. However, BB demonstrate significantly shorter positioning time compared to DLBT, and it is also associated with lower risks of multiple complications, including hoarseness, sore throat, tracheal injury, hypoxemia, and pneumonia, highlighting its safety advantage in postoperative care.