Bougie Trial

JAMA

December 8, 2021

Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation.

What was the research question?

Does the use of bougie (tracheal tube introducer) (intervention) increase the successful rate of intubation on the first attempt (outcome) in critically ill patients (population) compared to stylet intubation (comparator)?


How did they do it?

  • A multicenter, randomized, trial randomized 1102 critically-ill patients to between use of bougie compared to stylet for intubation.

  • Primary Outcome:

  1. Rate of successful intubation on the first attempt.

  • Secondary Outcome

  1. Rate of severe hypoxia.

  2. Rate of intubation complications: Esophageal intubation, injury to oral, glottic, or thoracic structures, or aspiration.

  3. Rate of pneumothorax.


What did they find?

  • Successful intubation on the first attempt did not differ between the bougie group compared to the stylet group (80.4% versus 83.0%). 

  • Severe hypoxemia was experienced in 11% in the bougie group compared to 8.8% of patients in the stylet group. 

  • No difference in esophageal intubation (0.7% vs 0.9% ).

  • Pnneumothorax was not different between the two groups (2.5% vs. 2.7%).


Any limitations?

Factors that may affect outcomes and limit generalizability

  • Excluded patients needing urgency of intubation or patients intubated using a hyperangulated laryngoscope, and patients for whom use of a bougie was specifically indicated.

  • Limited experience with bougie intubation.

  • Blinding cannot be done.

  • Applies only to the first attempt.


What does it mean?

Use of bougie did not improve the rate of successful intubation and is not preferred over stylet intubation. No change in the current practice based on this study within its limitations.

Bougie Trial