Bougies to increase first-pass intubation success
Meta-analysis says it helps, but would you use one every time?
Bougies (flexible tracheal tube introducers) are commonly used to facilitate endotracheal intubation, especially when the vocal cords and glottis are poorly seen. Their effectiveness and benefits may seem obvious to airway experts, but there has been limited evidence to support their use or best define the situations in which bougies are most helpful.
von Hellmann et al conducted a meta-analysis of 18 studies, including 12 randomized trials testing the use of bougies in emergent (9 studies, 8,070 patients) and nonemergent intubations (9 studies, 1,081 patients). Most patients were intubated with video laryngoscopy using Macintosh-style blades (although direct laryngoscopy was used in more studies, which enrolled fewer total patients).
Patients were randomized to the first attempt using a bougie, or without. Virtually all studies used rapid sequence intubation with a rapidly acting neuromuscular blocker.
The use of a bougie was associated with modestly increased first-pass success with …
Keep reading with a 7-day free trial
Subscribe to PulmCCM to keep reading this post and get 7 days of free access to the full post archives.