Videolaryngoscopy versus direct laryngoscopy for double-lumen tube intubation: the DOuble-Lumen intubation with VIdeolaryngoscopy (DOLVI) multicentre randomised trial

doi:10.1016/j.bja.2026.02.048

Airway management

Videolaryngoscopy versus direct laryngoscopy for double-lumen tube intubation: the DOuble-Lumen intubation with VIdeolaryngoscopy (DOLVI) multicentre randomised trial

Br J AnaesthPublished 24 Apr 2026Randomised controlled trial

Primary resultResultAbsolute risk difference 7.9 percentage points 95% CI 2.8–12.8

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Authors' conclusion

Among patients undergoing surgery requiring lung isolation, videolaryngoscopy increased first-attempt success and improved glottic visualisation while reducing procedural difficulty in double-lumen tube placement compared with direct laryngoscopy.

Study context

Population: Adults undergoing surgery requiring lung isolation, 4 Spanish hospitals
Participants: 916 adults

Comparison: Videolaryngoscopy vs Direct laryngoscopy
Videolaryngoscopyn = 458
Direct laryngoscopyn = 458reference
Primary endpoint: Successful intubation on the first attempt

Methodological detailsmulticentre

Multicentre

Primary result

As reported in the abstract

Absolute risk difference

7.9 percentage points

95% CI 2.8–12.8

P = 0.003

Events by treatment group

Videolaryngoscopy84.7%388 of 458

Direct laryngoscopy76.9%352 of 458

Videolaryngoscopy vs Direct laryngoscopy

absolute risk difference 7.9 percentage points (95% CI 2.8–12.8); P = 0.003

Secondary outcomes

Outcome	Videolaryngoscopy	Direct laryngoscopy	← Lower with videolaryngoscopy ←→ Higher with videolaryngoscopy →	Absolute risk difference (95% CI)	P value
Good glottic visualisation	93.7%	80.8%	−1001020	12.9% (8.6%–17.1%)	P < 0.001
Easy intubation	81.9%	68.6%	−1001020	13.3% (7.8%–18.8%)	P < 0.001
			−1001020Difference (linear scale)

External airway manipulation

P < 0.001

Videolaryngoscopy28.6%

Direct laryngoscopy40.6%

Intubation time

Similar between groups

Safety

Loss of glottic view

P < 0.001

Videolaryngoscopy4.4%

Direct laryngoscopy21.8%

Oesophageal intubation

P = 0.014

Videolaryngoscopy1.7%

Direct laryngoscopy4.6%

Double-lumen tube malposition

P = 0.016

Videolaryngoscopy7.6%

Direct laryngoscopy12.4%

Other complications

Similar between groups

Original publication

Videolaryngoscopy versus direct laryngoscopy for double-lumen tube intubation: the DOuble-Lumen intubation with VIdeolaryngoscopy (DOLVI) multicentre randomised trial. Br J Anaesth. Published 24 April 2026. doi:10.1016/j.bja.2026.02.048

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