UMEM Educational Pearls

Title: Bougie or Endotracheal Tube with Stylet for First Attempt?

Posted: 12/28/2021 by Mike Winters, MBA, MD
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The BOUGIE Trial

More than 1 million patients undergo endotracheal intubation each year in the US.
Up to 20% of intubations fail on the first attempt, thereby increasing the risk of adverse outcome.
Over the past several years, many have become comfortable using the bougie as a rescue device when the first attempt at intubation fails with an endotracheal tube with stylet.
In contrast to its use as a rescue device, should the bougie be used during the first attempt rather than an endotracheal tube with a malleable stylet?
The BOUGIE Trial compared the effect of using the bougie to an endotracheal tube with stylet on first attempt success in critically ill patients.
The trial enrolled 1106 patients in 7 EDs and 8 ICUs at 11 hospitals.
The primary outcome of first pass success was not statistically different between those randomized to bougie and those randomized to endotracheal tube with stylet for the first attempt at intubation..
Though the trial did not find a statistical difference in first pass success rates, the bougie remains an important device in our management of the critically ill airway.

References

Driver BE, et al. 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. JAMA. 2021. Published online December 8, 2021