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

Xiaoxi Li, Ling Yu, Jiaonan Yang, Jin Wei, Miao Fu, Hongyu Tan Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, People’s Republic of ChinaCorrespondence: Hongyu Tan, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Anesthesiology, Peking University Cancer Hospital & Institute, #52 Fucheng Street, Haidian District, Beijing, 100142, People’s Republic of China, Tel/Fax +8610-88196107, Email [email protected]: 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.Keywords: bronchial blocker, double-lumen endotracheal tube, lung cancer, video-assisted thoracoscopic surgery, postoperative pulmonary complication