Recent advances in double-lumen tube malposition in thoracic surgery: A bibliometric analysis and narrative literature review

Abstract

Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine "passive" chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, DLT malposition still occurs during transferring patients from a supine to the lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently, some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.

Keywords: airway management; bibliometric analysis; double lumen tube; fiberoptic bronchoscopy; malposition; one-lung ventilation; thoracic surgery.

Figure 1

(A) The network map of collaborating countries in DLT research. Annular size, reflecting the number of publications; purple circle size, reflecting the intensity of centrality (generally considered to be meaningful when >0.1), and centrality is reflecting the degree to which a node is connected to other nodes throughout the network. (B) The clustered network map of keywords on DLT research.