BOUGIE
Trial question
Is the use of bougie superior to an endotracheal tube with stylet in critically ill adults undergoing tracheal intubation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 1102
1102 patients (452 female, 650 male).
Inclusion criteria: critically ill adult patients undergoing tracheal intubation.
Key exclusion criteria: pregnancy; incarceration; immediate need for tracheal intubation without time for randomization; operator determines that use of a bougie or a stylet is required or contraindicated.
Interventions
N=556 bougie (use of bougie for the first attempt at tracheal intubation).
N=546 stylet (use of endotracheal tube with a malleable stylet for the first attempt at tracheal intubation).
Primary outcome
Successful intubation on first attempt
80.4%
83%
83.0 %
62.3 %
41.5 %
20.8 %
0.0 %
Bougie
Stylet
No significant
difference ↔
No significant difference in successful intubation on the first attempt (80.4% vs. 83%; ARD -2.6, 95% CI -7.3 to 2.2).
Secondary outcomes
No significant difference in severe hypoxemia (11% vs. 8.8%; ARD 2.2, 95% CI -1.6 to 6).
Significant decrease in the rate of death before 28 days (27.3% vs. 33.7%; ARD -6.4, 95% CI -12 to -0.8).
No significant difference in ventilator-free days (24 days vs. 22 days; DIM 2, 95% CI 0.5 to 6).
Safety outcomes
No significant differences in airway complications, pneumothorax after intubation.
Conclusion
In critically ill adult patients undergoing tracheal intubation, bougie was not superior to stylet with respect to successful intubation on the first attempt.
Reference
Brian E Driver, Matthew W Semler, Wesley H Self 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. 2021 Dec 28;326(24):2488-2497.
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