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

Abstract

This prospective, randomized, cross-over study compared the performance of the novel Flexible Tip Bougie™ (FTB) with a conventional bougie as an intubation aid in a simulated difficult airway manikin model among anaesthesiology trainees with regards of first pass success rate, time to intubation, number of attempts and ease of use. Sixty-two anesthesiology trainees, novice to the usage of FTB, participated in this study. Following a video demonstration, each participant performed endotracheal intubation on a manikin standardized to a difficult airway view. Each participant performed direct laryngoscopy and intubated the manikin using a conventional bougie and FTB, at least 1 day in between devices, in a randomized order. The first pass success rate was significantly higher with FTB (98.4%) compared to conventional bougie (85.5%), p = 0.008. The median time to intubation was significantly faster when using FTB, median = 32.0 s [Interquartile range (IQR): 23.8–41.3 s] compared to when using conventional bougie, median = 41.5 s (IQR: 31.8–69.5 s), p < 0.001. The FTB required significantly less intubation attempts compared to conventional bougie, p = 0.024. The overall ease of use, scored on a Likert scale from 1 to 5, was significantly higher in the FTB (4.26 ± 0.53) compared to the conventional bougie (3.19 ± 0.83), p < 0.001. This simulated difficult airway manikin study finding suggested that FTB is a useful adjunct for difficult airway intubation. The FTB offered a higher first pass success rate with a faster time to intubation and less required attempts.

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

“…Mahli et al demonstrated that the intubation time was significantly faster with the Flexible Tip Bougie (32.0 s) than the Portex Single-Use Introducer (41.5 s). 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).…”

“…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.…”

“…Our results are in line with those obtained by Mahli et al, which indicated that the Flexible Tip Bougie (98.4%) had significantly higher success rate than the Portex Single-Use Introducer (85.5%). 10 Another study by Evrin et al concluded that the success rate of the Flexible Tip Bougie group (91.3%) was higher than for a standard bougie (SUMI, Sulejowek, Poland; 73.9%). 14 Research carried out by Frass et al also showed the Flexible Tip Bougie (51.4%) to be superior than a standard bougie stylet (ONTEX, Chennai, India; 37.8%) in term of intubation success rate.…”

“…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.…”