Ultrasound vs. Auscultation and Fiberoptic Bronchoscopy for Double-Lumen Tube Placement

Izmir City Hospital100 enrolled

Overview

One-lung ventilation is frequently required in thoracic surgery and is most commonly achieved using double-lumen endobronchial tubes (DLTs). Correct positioning of the DLT is crucial for effective lung isolation and patient safety. Fiberoptic bronchoscopy (FOB) is considered the gold standard for confirming DLT placement; however, it may not always be immediately available and requires specific expertise. Lung ultrasonography is a rapid, noninvasive, and bedside imaging method increasingly used in anesthesiology and critical care. This prospective observational study aims to evaluate the diagnostic performance of lung ultrasound in confirming the correct position of double-lumen endobronchial tubes in patients undergoing thoracic surgery. The results obtained from lung ultrasound will be compared with auscultation findings and fiberoptic bronchoscopy results. Fiberoptic bronchoscopy will be considered the reference standard. The sensitivity, specificity, positive predictive value, and negative predictive value of lung ultrasound and auscultation will be calculated.

Study Type

OBSERVATIONAL

Enrollment

100

Conditions

Thoracic Surgery With One-lung Ventilation

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 18 and 65 years * Scheduled for elective thoracic surgery * Planned one-lung ventilation * Use of double-lumen endobronchial tube * ASA physical status I-III * Written informed consent obtained Exclusion Criteria: * Known airway anomalies * Previous lung resection surgery * Tracheostomy * Coagulopathy * Pleural effusion or pleural pathology that may interfere with lung ultrasound evaluation * Chest wall deformity * Emergency surgery * Patients who decline participation

Outcomes

Primary Outcomes

Diagnostic accuracy of lung ultrasound for confirmation of double-lumen tube placement

Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy of lung ultrasound in confirming correct double-lumen endobronchial tube placement compared with fiberoptic bronchoscopy as the reference standard.

Time frame: Intraoperative (immediately after DLT placement)

Secondary Outcomes

Agreement between methods

Agreement between lung ultrasound, auscultation, and fiberoptic bronchoscopy in confirming DLT position will be evaluated using Cohen's kappa coefficient.

Time frame: Intraoperative

Diagnostic accuracy of auscultation for confirmation of double-lumen tube placement

Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of auscultation for confirming correct double-lumen tube placement compared with fiberoptic bronchoscopy.

Time frame: Intraoperative

Time required to confirm correct double-lumen tube placement

Time required to confirm correct double-lumen endobronchial tube position using lung ultrasound, auscultation and fiberoptic bronchoskopy.

Time frame: Immediately after tube placement

Effect of right- versus left-sided double-lumen endobronchial tubes on diagnostic performance

Comparison of the diagnostic performance of lung ultrasound and auscultation for confirming correct double-lumen endobronchial tube position in right-sided versus left-sided double-lumen tubes, using fiberoptic bronchoscopy as the reference standard. Measures will include sensitivity, specificity, PPV, NPV, and overall accuracy within each DLT type.

Time frame: ıntraoperative (immediately after DLT placement)