Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

Abstract

Background: Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods: We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results: Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization.

The Performance of Flexible Tip Bougie™ in Intubating Simulated Difficult Airway Model

“…We reported a statistically significant shorter time to a successful intubation by 9.1 s with lesser number of attempts required when the trainees used FTB compared to conventional bougie as an intubation aid. A recent simulation study with cervical immobilization compared the use of FTB and standard bougie also reported a faster duration of to a successful intubation with the FTB, 37 vs. 46 s (p < 0.001) (16). Another manikin study evaluated the usage of the two bougies for intubation during cardiopulmonary resuscitation and reported a statistically shorter intubation time (21.4 s) with the FTB compared to the gum elastic bougie (25.7 s), p < 0.001 (15).…”

“…The FTB was perceived as easier to be used compared to the conventional bougie amongst our trainees. Ruetzler et al also reported that the FTB was easier to use in difficult intubation situations especially in scenarios that involve limited cervical movement (16). The curve of the FTB resembles the anatomical airway curvature, thus facilitating its insertion into the hypopharynx region.…”

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

“…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].…”

Rhinologic Practice Special Considerations During COVID‐19: Visit Planning, Personal Protective Equipment, Testing, and Environmental Controls

“…1 The average time for intubation varies between <1 minute to 25 minutes depending on the situation (emergent vs planned) and difficulty. 9,10 For rhinologists, their surgical cases and clinic procedures may meet criteria for high-risk AGPs due to their duration and the staff’s proximity to the airway. Physicians should also be cognizant that speech itself is aerosol generating and thus engage in only essential conversation when in close proximity of an unmasked patient.…”