Preoperative lung ultrasound for confirming the double-lumen endotracheal tube position for one-lung ventilation: A systematic review and meta-analysis

OBJECTIVES: Insertion of a double-lumen endotracheal tube (DLT) is the most commonly used method for one-lung ventilation (OLV). This meta-analysis was aimed at investigating the performance of lung ultrasound in assessing the DLT position in OLV. METHODS: Electronic databases were searched for related trials from inception to October 2022. The primary outcome was the performance of ultrasound or clinical evaluation in confirming the correctness of the DLT position, using fiberoptic bronchoscopy or intraoperative direct visualization of lung collapse as the gold standard. The secondary outcome was the time required to confirm or adjust the DTL position. RESULTS: Five randomized controlled trials and three observational studies involving 771 patients were included in the meta-analysis. The pooled sensitivity and specificity of ultrasound were 0.93 (95% confidence interval [CI]: 0.79–0.98) and 0.61 (95% CI: 0.41–0.77), respectively, while those of clinical evaluation were 0.93 (95% CI: 0.73–0.99) and 0.35 (95% CI: 0.25–0.47), respectively. The pooled procedure duration was 122.27 s (95% CI: 20.85–223.69) with ultrasound and 112.03 s (95% CI: 95.30–128.76) with clinical evaluation. The area under the curve for discriminating the DLT position was 0.86 (95% CI: 0.82–0.88) for ultrasound and 0.52 (95% CI: 0.48–0.57) for clinical evaluation. CONCLUSIONS: Compared to clinical evaluation, ultrasound has a similar sensitivity but a better specificity for confirming the correctness of the DLT position. Ultrasound is an acceptable imaging tool for assessing DTL placement in OLV.