A randomised crossover comparison of two endotracheal tube introducers: the FROVA and the Flexible Tip Bougie for GlideScope intubation of a difficult airway manikin by infrequent intubators

Abstract

Background: This unblinded randomised crossover study compares two endotracheal tube introducers (ETIs): the FROVA and the "Flexible Tip Bougie" (FTB), in an airway manikin mimicking difficult intubation with a percentage of glottic opening view of 30%. Participants were Emergency Medicine and Anaesthesia trainees with recent experience of less than twenty patient intubations. The primary outcome was time to intubation, further divided into time taken to pass the ETI and time to railroad the endotracheal tube (ETT) over the ETI. The secondary outcome was the difficulty of intubation. Results: The median total time to ETT placement was significantly shorter with the FTB (37.5 s) compared with the FROVA ETI (63.0 s), P = 0.0006. The median difficulty reported (scores 0-10 with 0 being no difficulty) with the FTB was 2 compared with 5 for the FROVA, P < 0.0001. Conclusions: The FTB enabled significantly faster and easier placement of the endotracheal tube compared with the FROVA in inexperienced hands intubating a difficult intubation manikin.

Standard and flexible tip bougie for tracheal intubation using a non‐channelled hyperangulated videolaryngoscope: a randomised comparison#

“…There was no significant difference in the first attempt success rate between two groups. Alternative techniques to aid tube delivery with videolaryngoscopes have been described including stylets [22] and fibreoptic assisted videolaryngoscopy [23]. Despite the difference in bougie impingement, we were not able to demonstrate any statistically significant difference in incidence or severity of postoperative sore throat between the two groups.…”

“…We are not aware of any previous comparable clinical trials using flexible tip bougies. However, a significantly reduced anterior tracheal wall impingement, reduced number of optimisation manoeuvres and shorter intubation time has been observed in manikin studies using a flexible tip bougie when compared with a standard bougie [22, 23].…”

Evaluation of Flexible Tip bougie in simulated difficult intubation: a randomized cross-over manikin study

“…10 Another study conducted by Cormack et al obtained results indicating that total intubation time was significantly shorter with the Flexible Tip Bougie (37.5 s) compared to the Frova Intubating Introducer (63.0 s). 11 Additionally, the results from Evrin et al also showed that intubation time was significantly faster with the Flexible Tip Bougie (29.0 s) than a standard bougie (38.0 s). 14 Again, the intubation time with the Flexible Tip Bougie (37.0 s) was significantly shorter than with a standard bougie (55.0 s) in a study by Frass et al 9 Brunckhorst et al also concluded that the intubation time was significantly faster with the Flexible Tip Bougie (77.2 s) as compared to the Frova Intubating Introducer (142.2 s).…”

“…The results remain in line with several previous studies which were in favour of the Flexible Tip Bougie compared to others in term of ease of use. [7][8][9][10][11]14 According to feedback from the participants, the Flexible Tip Bougie is easier to use because of its anterior curve of body and the flexible tip that can be directed both anteriorly and posteriorly. In the scenario of difficult airway, it is important to select the easiest to use and most familiar bougie to facilitate successful intubation.…”

“…A few recent studies that evaluated the efficacy of the Flexible Tip Bougie among medical personnel showed positive results. 7,[9][10][11] This study aimed to compare the efficacy of Flexible Tip Bougie with the Portex Single-Use Introducer (Smiths Medical, Minneapolis, MN, USA) and the Frova Intubating Introducer (Cook Medical, Bloomington, IN, USA) in simulated difficult intubation in terms of successful rate of intubation, intubation time, and ease of use in order to explore a better bougie.…”