biostudies-literatureDriver BENCATS NIH HHSNCRR NIH HHSNHLBI NIH HHS2488-2497https://www.ebi.ac.uk/biostudies/studies/S-EPMC8655668biostudies-literatureUnknown326(24)<h4>Importance</h4>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.<h4>Objective</h4>To determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt.<h4>Design, setting, and participants</h4>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.<h4>Interventions</h4>Patients were randomly assigned to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546).<h4>Main outcomes and measures</h4>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%.<h4>Results</h4>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.<h4>Conclusions and relevance</h4>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.<h4>Trial registration</h4>ClinicalTrials.gov Identifier: NCT03928925JAMAEffect 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.PMC8655668K23 HL143053UL1 RR024975K12 HL133117T32 HL105346K08 HL148514UL1 TR000445K23 HL153584Sarratt LStang JO'Connor KLyle CPereira GBRice TWMitchell SHPatel SDFarmer EAHughes CGGaillard JPLatimer AJWang LSemler MWDemasi SCLacy AJDuran DASmith LMWestphal NDBentov IBardita CFord KKWest JRBOUGIE Investigators and the Pragmatic Critical Care Research GroupFriedel JDriver BESelf WHWatase TMattox TSKelmenson DVonderhaar DJRice ELMaruggi EMason AMDefebio ATDoerschug KCJanz DRWhitson MRGinde AAAltz-Stamm ADunn JGoyack LEHigh KBoone MCKurz MCStigler WSCasey JDFletcher ANowak JOeth JNTrent SAKoppurapu VSWhite GLloyd BGandotra SRobison SWLindsell CJHowell MPCupelo AKHerder SGibbs KWWithers CLandsperger JSNava KMBarnes CMDrescher AGray CSPage DBJoshi RVijaykumar KHarris NHudali TMohamed FOtoo AEjem SJackson KEGautney JJoffe AMAlvis BDMitchell RRussell DWMerriman SRGulati SStewart TPrekker MEDeVries PDsouza KGAnderson LDye SGravitz SWade RCChiles JWMoore MMkorombindo TCollins KfalseEffect 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.<h4>Importance</h4>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.<h4>Objective</h4>To determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt.<h4>Design, setting, and participants</h4>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.<h4>Interventions</h4>Patients were randomly assigned to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546).<h4>Main outcomes and measures</h4>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%.<h4>Results</h4>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.<h4>Conclusions and relevance</h4>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.<h4>Trial registration</h4>ClinicalTrials.gov Identifier: NCT039289252021-01-01T00:00:00Z2021 Dec2024-11-15T17:58:31.129Z2024-11-15T17:58:31.129ZS-EPMC86556683487914310.1001/jama.2021.22002