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.