Learning Curve Analysis of Double-Lumen Tube Placement in Anesthesiology Residents: The Impact of Prior Experience and Laryngoscope Type

NCT07569107 | Not Yet Recruiting

• 1 other identifier: 2024-BÇEK/543
• Study Type: observational
• Target: 33
• Locations: 1 country
• Sites: 1

Brief Summary

Placement of a double-lumen tube (DLT) is one of the fundamental techniques for safely achieving one-lung ventilation in thoracic anesthesia. Compared with standard single-lumen endotracheal tubes, DLTs have a larger diameter, greater length, and a more rigid structure. These characteristics make intubation with a DLT considerably more challenging in both normal and difficult airways, potentially increasing the risk of upper airway trauma and postoperative complications, thereby contributing to increased overall morbidity and mortality. Despite its widespread clinical use, DLT placement remains a technically demanding procedure due to anatomical variability, limited visualization, and operator-dependent performance differences. The reported incidence of DLT malposition in the literature ranges from 32% to 83%. Even in studies reporting lower rates (approximately 32.44%), it is acknowledged that a substantial number of malpositions may go undetected, which can critically impact both patient safety and surgical outcomes. In addition to initial misplacement, repeated repositioning of a malpositioned DLT may itself lead to airway injury. Increased manipulation of the DLT within the bronchial tree may result in excessive trauma. DLT malposition may predispose patients to inadequate lung isolation, hypoxemia, tracheobronchial injury, and potential complications such as barotrauma or pneumothorax. Operator experience is recognized as a key determinant of success in airway management. Previous studies have demonstrated that technical proficiency in advanced airway interventions improves with cumulative clinical experience. However, most existing research has focused on basic airway devices, and evidence regarding advanced airway techniques such as DLT placement remains limited. Furthermore, the relative contributions of operator experience, airway difficulty, and device technology to procedural success have not been fully elucidated. To address the need for easier and safer endotracheal intubation, various types of video laryngoscopes have been developed as alternatives to direct laryngoscopy . Nevertheless, it remains unclear whether video-assisted airway management reduces DLT malposition rates across different levels of operator experience. Simulation-based training has become increasingly important in modern anesthesiology education, providing a safe and standardized environment for the assessment of airway management skills. Accordingly, there is a need for simulation-based studies evaluating learning curves and technical performance in DLT placement. The primary aim of this study is to evaluate the effects of overall clinical experience and prior DLT placement experience on malposition rates during DLT insertion procedures performed in a simulation setting among anesthesiology residents. Secondary objectives include comparing the performance of video laryngoscopy and Macintosh laryngoscopy, as well as analyzing learning curves across repeated attempts. Additionally, the interaction between experience level, type of laryngoscope used, and airway difficulty will be investigated. Study Design and Population This study will be conducted in accordance with the Declaration of Helsinki and will be carried out at Ankara Atatürk Sanatorium Training and Research Hospital after obtaining approval from the institutional ethics committee. The study is designed as a prospective, observer-blinded, simulation-based study with repeated measures. It aims to evaluate DLT placement performance using standardized airway simulation models. All anesthesiology residents working in the Department of Anesthesiology and Reanimation at Ankara Atatürk Sanatorium Training and Research Hospital will be invited to participate on a voluntary basis (total of 33 participants). Written informed consent will be obtained from all participants. Anesthesiology residents with varying levels of experience will be included voluntarily. Participants will be stratified based on years of residency training and the number of prior DLT placements performed. Airway simulation will be conducted using high-fidelity airway manikins equipped with bronchial anatomy modules. Intubation will be performed using a 37 Fr DLT. Simulation platforms with fiberoptic verification capability will be utilized. Prior to data collection, participants will receive standardized training on DLT placement.

Conditions

Learning Curves and Outcomes of Simulation-based Training; Double Lumen Tube Intubation; Anesthesiology Residency Training; Experience; Laryngoscopes

Keywords

Learning curves; simulation -based training; double lumen tube; experience; laryngoscopes; anesthesiology residents

Outcome Measures

Primary Outcomes (2)

• • Total number of DLT malpositions confirmed by fiberoptic bronchoscopy

  Malposition is defined as any of the following: * Failure of the bronchial cuff to be positioned in the left main bronchus, remaining instead in the trachea * Unintentional placement of the DLT into the right bronchial system * Advancement of the DLT at least 1 cm beyond the optimal position within the left main bronchus

  DLT intubation will be completed within 48 hours. The total number of malpositions within 48 hours will be recorded.

• DLT malpositions

  Malposition is defined as any of the following: * Failure of the bronchial cuff to be positioned in the left main bronchus, remaining instead in the trachea * Unintentional placement of the DLT into the right bronchial system * Advancement of the DLT at least 1 cm beyond the optimal position within the left main bronchus

  1 hour

Study Arms (1)

Anesthesiology residents with varying levels of experience

Anesthesiology residents with varying levels of experience will be included voluntarily. Participants will be stratified based on years of residency training and the number of prior DLT placements performed.

Other: Double lumen tube entubation

Interventions

Double lumen tube entubation OTHER

Anesthesiology residents with varying levels of experience will be included voluntarily. Participants will be stratified based on years of residency training and the number of prior DLT placements performed. Airway simulation will be conducted using high-fidelity airway manikins equipped with bronchial anatomy modules. Intubation will be performed using a 37 Fr DLT. Simulation platforms with fiberoptic verification capability will be utilized. Prior to data collection, participants will receive standardized training on DLT placement. Each participant will perform the following four clinical scenarios in a randomized order: 1. Scenario: Normal airway - Macintosh laryngoscope 2. Scenario: Normal airway - Video laryngoscope 3. Scenario: Difficult airway - Macintosh laryngoscope 4. Scenario: Difficult airway - Video laryngoscope Participants will complete the scenarios in different sequences, determined by computer-based randomization.

Anesthesiology residents with varying levels of experience

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

• Being an anesthesiology resident at the Ankara Atatürk Sanatorium Training and Research Hospital

You may qualify if:

• Being an anesthesiology resident at the study institution
• Voluntary participation

You may not qualify if:

• Refusal to participate in the study
• Prior participation in the same simulation scenario

Sponsors & Collaborators

• Ankara Ataturk Sanatorium Training and Research Hospital: lead

Study Sites (1)

Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, 06280

Ankara, Turkey (Türkiye)

Location

Study Officials

• Ramazan BALDEMİR

  ANKARA ATATURK SANATORİUM TRAİNİNG AND RESEARCH HOSPITAL

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ramazan BALDEMİR, clinic Associate Professor

CONTACT

+905303570166; baldemir2323@gmail.com

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinic Associate Professor

Study Record Dates

• First Submitted: April 29, 2026
• First Posted: May 6, 2026
• Study Start (Estimated): May 10, 2026
• Primary Completion (Estimated): August 10, 2026
• Study Completion (Estimated): August 10, 2026
• Last Updated: May 6, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)