Use of Bougie fails to ensure successful Intubation in first attempt in Critically ill patients: JAMA

According to a new study conducted by Brian E. Driver and colleagues, the use of a bougie did not significantly increase the incidence of successful intubation on the first attempt among critically ill adults undergoing tracheal intubation when compared to the use of an endotracheal tube with stylet.

The findings of this study were published in the Journal of American Medical Association.

Failure to intubate the trachea on the first attempt occurs in up to 20% of critically ill adults undergoing emergency tracheal intubation, and is associated with severe hypoxemia and cardiac arrest. It is unclear whether using a tracheal tube introducer ("bougie") increases the likelihood of successful intubation over using an endotracheal tube with a stylet. As a result, this study was carried out with the goal of determining the effect of using a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt.

The Bougie or Stylet in Patients Undergoing Intubation Emergently (BOUGIE) trial enrolled 1102 critically ill adults undergoing tracheal intubation in 7 emergency departments and 8 intensive care units in the United States between April 29, 2019, and February 14, 2021; the final follow-up date was March 14, 2021. Interventions Patients were randomly assigned to receive either a bougie (n = 556) or an endotracheal tube with a stylet (n = 546). The main result was successful intubation on the first try. The incidence of severe hypoxemia, defined as a peripheral oxygen saturation less than 80%, was the secondary outcome.

Main outcomes:

1. 1102 (99.6%) of the 1106 patients randomized completed the trial and were included in the primary analysis.

2. In the bougie group, 447 patients (80.4%) were successfully intubated on the first attempt, while 453 patients (83.0%) were successfully intubated on the second attempt.

3. In the bougie group, 58 patients (11.0%) experienced severe hypoxemia, compared to 46 patients (8.8%) in the stylet group. Pneumothorax was present after intubation in 14 patients (2.5%) in the bougie group and 15 patients (2.7%) in the stylet group, and injury to oral, glottic, or thoracic structures occurred in 0 patients in the bougie group and 3 patients (0.5 percent) in the stylet group.

In conclusion, the use of a bougie did not significantly increase the incidence of successful intubation on the first attempt among critically ill adults undergoing tracheal intubation when compared to the use of an endotracheal tube with stylet.

Reference:

Driver BE, Semler MW, Self WH, 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: A Randomized Clinical Trial. JAMA. Published online December 08, 2021. doi:10.1001/jama.2021.22002