Utility of bronchial blocker placement in the lateral versus supine position for thoracoscopic surgery: a randomised controlled trial in China

作者：Rongjun Liu, Renli Wang, Xizhen Liu, Fanfu Zeng, Junping Chen, Jianliang Sun, Xiaoyu Li, Bo Lu · 发表于：EClinicalMedicine · 年份：2026 · DOI：10.1016/j.eclinm.2026.104020 · 研究领域：Anesthesia and Pain Management、Lung Cancer Diagnosis and Treatment、Anesthesia and Sedative Agents

Background: Bronchial blocker (BB) displacement after supine placement and subsequent patient repositioning remains a significant challenge during video-assisted thoracoscopic surgery (VATS). We aimed to test the hypothesis that placing the BB in the lateral decubitus position after standard supine tracheal intubation would reduce the incidence of malposition compared to conventional supine placement. Methods: In this single-centre, prospective, randomised, single-blind, controlled trial conducted in China, 120 adult patients scheduled for VATS requiring one-lung ventilation were randomly assigned to either the Supine group (BB placed supine before turning lateral) or the Lateral group (BB placed after positioning the patient lateral). The primary outcome was the incidence of BB malposition, defined as the proportion of patients requiring BB repositioning (movement >1.0 cm) during the pre-incision fibreoptic bronchoscopic (FOB) check, assessed in the per-protocol population. The trial was registered with the Chinese Clinical Trial Registry, ChiCTR2400093699. Findings: Between Jan 13 and May 15, 2025, among 118 patients analysed per-protocol, the incidence of BB malposition was 0% (0/59) in the lateral group compared to 42.4% (25/59) in the Supine group (Firth's penalised OR 0.011, 95% CI 0.000-0.086; p < 0.001). The absolute risk reduction was 42.4% (95% CI 28.6-54.1) with a number needed to treat of 2.36 (95% CI 1.85-3.47). Regarding the safety profile, the overall incidence...