Flexible-tip bougie vs. stylet for tracheal intubation with a hyperangulated videolaryngoscope in critical care: a randomised controlled trial.

Summary

In ICU intubations using a hyperangulated videolaryngoscope, a flexible-tip bougie achieved a 99% first-attempt success rate versus 83% with a stylet, with less need for laryngeal manipulation and no increase in complications.

Key Findings

• First-attempt success: 99% (flexible-tip bougie) vs 83% (stylet), P=0.005.
• Fewer laryngeal manipulations with bougie: 10% vs 31.4%.
• No significant difference in complication rates between techniques.
• Operator-rated difficulty favored bougie (not difficult/slightly difficult in 99% vs 90%).

Clinical Implications

Prefer a flexible-tip bougie rather than a stylet when using hyperangulated videolaryngoscopes in ICU to maximize first-pass success and minimize adjunct maneuvers.

Limitations

• Single-center trial and lack of blinding of operators
• Results limited to hyperangulated videolaryngoscopes; generalizability to standard blades uncertain

Future Directions

Validate findings across multiple centers, operator experience levels, and different hyperangulated platforms; assess effects on hypoxemia and hemodynamic instability.