Flexible-Tip Bougie vs. Stylet for Videolaryngoscopic Intubation
Trial question
What is the role of flexible-tip bougie hyperangulated blade videolaryngoscope in critically ill patients who required tracheal intubation?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
29.0% female
71.0% male
N = 140
140 patients (40 female, 100 male).
Inclusion criteria: adult ICU patients undergoing tracheal intubation with a hyperangulated blade videolaryngoscope.
Key exclusion criteria: no informed consent; pregnancy; need for awake tracheal intubation; urgent need for immediate tracheal intubation.
Interventions
N=70 flexible-tip bougie (hyperangulated blade videolaryngoscope with a flexible-tip bougie).
N=70 stylet (hyperangulated blade videolaryngoscope with a tracheal tube loaded with a stylet).
Primary outcome
First-attempt tracheal intubation success
99%
83%
99.0 %
74.3 %
49.5 %
24.8 %
0.0 %
Flexible-tip
bougie
Stylet
Significant
increase ▲
NNT = 6
Significant increase in first-attempt tracheal intubation success (99% vs. 83%; AD 16%, 95% CI 4.84 to 27.16).
Secondary outcomes
Significant decrease in laryngeal manipulation (10% vs. 31%; ARD -21, 95% CI -34.29 to -7.71).
No significant difference in no difficulty in tracheal intubation (79% vs. 67%; AD 12%, 95% CI -1.89 to 25.89).
No significant difference in best modified Cormack-Lehane view, grade 1 (96% vs. 90%; AD 6%, 95% CI -8.05 to 20.05).
Safety outcomes
No significant difference in complications.
Conclusion
In adult ICU patients undergoing tracheal intubation with a hyperangulated blade videolaryngoscope, flexible-tip bougie was superior to stylet with respect to a first-attempt tracheal intubation success.
Reference
Manuel Taboada, Agustín Cariñena, Ana Estany-Gestal et al. Flexible-tip bougie vs. stylet for tracheal intubation with a hyperangulated videolaryngoscope in critical care: a randomised controlled trial. Anaesthesia. 2025 Mar 30. Online ahead of print.
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