Comparison of Preloaded Bougie versus Standard Bougie Technique for Endotracheal Intubation in a Cadaveric Model

Abstract

IntroductionWe compared intubating with a preloaded bougie (PB) against standard bougie technique in terms of success rates, time to successful intubation and provider preference on a cadaveric airway model.MethodsIn this prospective, crossover study, healthcare providers intubated a cadaver using the PB technique and the standard bougie technique. Participants were randomly assigned to start with either technique. Following standardized training and practice, procedural success and time for each technique was recorded for each participant. Subsequently, participants were asked to rate their perceived ease of intubation on a visual analogue scale of 1 to 10 (1=difficult and 10=easy) and to select which technique they preferred.Results47 participants with variable experience intubating were enrolled at an emergency medicine intern airway course. The success rate of all groups for both techniques was equal (95.7%). The range of times to completion for the standard bougie technique was 16.0–70.2 seconds, with a mean time of 29.7 seconds. The range of times to completion for the PB technique was 15.7–110.9 seconds, with a mean time of 29.4 seconds. There was a non-significant difference of 0.3 seconds (95% confidence interval −2.8 to 3.4 seconds) between the two techniques. Participants rated the relative ease of intubation as 7.3/10 for the standard technique and 7.6/10 for the preloaded technique (p=0.53, 95% confidence interval of the difference −0.97 to 0.50). Thirty of 47 participants subjectively preferred the PB technique (p=0.039).ConclusionThere was no significant difference in success or time to intubation between standard bougie and PB techniques. The majority of participants in this study preferred the PB technique. Until a clear and clinically significant difference is found between these techniques, emergency airway operators should feel confident in using the technique with which they are most comfortable.

Comparison of four methods of endotracheal tube passage in simulated airways: There is room for improved techniques

“…A literature review showed eight studies on the performance of bougies and stylets . One manikin study with 24 participants investigated FPS of the naked ETT, achieving a 46% FPS .…”

The adjuncts for endotracheal tube passage in simulated pediatric airways (AET‐SPA) study

“…However, neither study involved any pediatric patients. Similarly, studies using simulated airways, 1 , 15 , 16 , 17 , 18 , 19 , 20 cadavers, 21 , 22 and patients undergoing elective surgeries 23 to compare the first‐pass success rates of bougie, stylet, and naked endotracheal tube have all used adult subjects.…”

“… 11 , 12 Research investigating the efficacy of stylets in first‐pass success in pediatric patients has been limited to 2 neonatal studies. 13 , 14 Likewise, studies using airway manikins, 1 , 15 , 16 , 17 , 18 , 19 , 20 cadavers, 21 , 22 and elective surgical patients 23 to compare the efficacy of bougie and stylet have used only adult subjects.…”

Endotracheal intubation in patients with difficult airway: Using laryngeal mask airway with bougie versus video laryngoscopy

“…Based on other studies, the success rates of bougie have been reported to range from 74% to 99% in difficult intubation. 25 In a study by Shah et al 26 to determine the success rate of endotracheal intubation in the emergency department using a plastic bougie, the device was found to have a success rate of 73.7% when used as a means of airway management in patients with difficult airways.…”