Journal article
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 : the journal of the American Medical Association, Vol.326(24), pp.2488-2497
12/28/2021
DOI: 10.1001/jama.2021.22002
PMCID: PMC8655668
PMID: 34879143
Abstract
For critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube introducer ("bougie") increases the likelihood of successful intubation compared with using an endotracheal tube with stylet remains uncertain.
To determine the effect of use of 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 was a multicenter, randomized clinical trial among 1102 critically ill adults undergoing tracheal intubation in 7 emergency departments and 8 intensive care units in the US between April 29, 2019, and February 14, 2021; the date of final follow-up was March 14, 2021.
Patients were randomly assigned to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546).
The primary outcome was successful intubation on the first attempt. The secondary outcome was the incidence of severe hypoxemia, defined as a peripheral oxygen saturation less than 80%.
Among 1106 patients randomized, 1102 (99.6%) completed the trial and were included in the primary analysis (median age, 58 years; 41.0% women). Successful intubation on the first attempt occurred in 447 patients (80.4%) in the bougie group and 453 patients (83.0%) in the stylet group (absolute risk difference, -2.6 percentage points [95% CI, -7.3 to 2.2]; P = .27). A total of 58 patients (11.0%) in the bougie group experienced severe hypoxemia, compared with 46 patients (8.8%) in the stylet group (absolute risk difference, 2.2 percentage points [95% CI, -1.6 to 6.0]). Esophageal intubation occurred in 4 patients (0.7%) in the bougie group and 5 patients (0.9%) 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%) in the stylet group.
Among critically ill adults undergoing tracheal intubation, use of a bougie did not significantly increase the incidence of successful intubation on the first attempt compared with use of an endotracheal tube with stylet.
ClinicalTrials.gov Identifier: NCT03928925.
Details
- Title: Subtitle
- 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
- Creators
- Brian E Driver - Hennepin County Medical CenterMatthew W Semler - Vanderbilt University Medical CenterWesley H Self - Vanderbilt University Medical CenterAdit A Ginde - University of Colorado DenverStacy A Trent - University of Colorado DenverSheetal Gandotra - University of Alabama at BirminghamLane M Smith - Atrium Health Wake Forest BaptistDavid B Page - University of Alabama at BirminghamDerek J Vonderhaar - Ochsner Health SystemJason R West - Lincoln Medical CenterAaron M Joffe - University of WashingtonSteven H Mitchell - University of WashingtonKevin C Doerschug - University of IowaChristopher G Hughes - Vanderbilt University Medical CenterKevin High - Vanderbilt University Medical CenterJanna S Landsperger - Vanderbilt University Medical CenterKaren E Jackson - Vanderbilt University Medical CenterMichelle P Howell - University of Colorado DenverSarah W Robison - University of Alabama at BirminghamJohn P Gaillard - Atrium Health Wake Forest BaptistMicah R Whitson - University of Alabama at BirminghamChristopher M Barnes - University of WashingtonAndrew J Latimer - University of WashingtonVikas S Koppurapu - University of IowaBret D Alvis - Vanderbilt University Medical CenterDerek W Russell - University of Alabama at BirminghamKevin W Gibbs - Wake Forest UniversityLi Wang - Vanderbilt University Medical CenterChristopher J Lindsell - Vanderbilt University Medical CenterDavid R Janz - University Medical Center New OrleansTodd W Rice - Vanderbilt University Medical CenterMatthew E Prekker - Hennepin County Medical CenterJonathan D Casey - Vanderbilt University Medical CenterBOUGIE Investigators and the Pragmatic Critical Care Research Group
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.326(24), pp.2488-2497
- DOI
- 10.1001/jama.2021.22002
- PMID
- 34879143
- PMCID
- PMC8655668
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Grant note
- K23 HL153584 / NHLBI NIH HHS UL1 RR024975 / NCRR NIH HHS T32 HL105346 / NHLBI NIH HHS K12 HL133117 / NHLBI NIH HHS UL1 TR000445 / NCATS NIH HHS K08 HL148514 / NHLBI NIH HHS K23 HL143053 / NHLBI NIH HHS
- Language
- English
- Date published
- 12/28/2021
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984359868102771
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