Abstract

BACKGROUND: Endotracheal intubation (ETI) is a procedure widely performed for several clinical indications. In typical ETI, an endotracheal tube is placed into a patient's trachea with the help of a malleable metal rod covered with a clear plastic sheath (called a stylet). However, another intubation aid, a bougie (also named a gum elastic bougie or endotracheal tube introducer), was also introduced in the clinical setting to improve the efficacy of conventional ETI.

METHODS: This study performed a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of bougie and stylet approaches in ETI. PubMed, Embase, and Cochrane Library databases were searched for studies published before November 2018. Randomized controlled trials comparing the clinical outcomes of bougie and stylet approaches in patients who underwent orotracheal intubation were included. Meta-analyses were conducted by using a random effects model, and treatment efficacy was measured by evaluating the first-attempt success rate and intubation duration.

RESULTS: A total of 5 randomized controlled trials and 1,038 patients were included. Although a bougie resulted in a better first-attempt success rate, no significant difference was observed between the approaches (risk ratios, 1.03; 95% confidence interval, 0.85-1.24). Moreover, no significant differences were observed in the intubation duration and esophageal intubation rate between the bougie and stylet approaches.

CONCLUSION: Endotracheal intubation performed with a bougie was not superior over ETI performed with a stylet. Therefore, intubation approaches should be selected by considering personal preference and clinician expertise.

LEVEL OF EVIDENCE: Systematic review and meta-analysis, level II.

Original languageEnglish
Pages (from-to)902-908
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number5
DOIs
Publication statusPublished - May 1 2019

Fingerprint

Intratracheal Intubation
Intubation
Meta-Analysis
Randomized Controlled Trials
Gingiva
Trachea
PubMed
Plastics
Libraries
Metals
Odds Ratio
Databases
Confidence Intervals

Keywords

  • Endotracheal intubation
  • bougie
  • endotracheal tube introducer
  • orotracheal intubation
  • stylet

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

@article{dff69b95a5934d56bfb913d3efd2dc8b,
title = "Comparison of the Efficacy of A Bougie and Stylet in Patients With Endotracheal Intubation: A Meta-Analysis of Randomized Controlled Trials",
abstract = "BACKGROUND: Endotracheal intubation (ETI) is a procedure widely performed for several clinical indications. In typical ETI, an endotracheal tube is placed into a patient's trachea with the help of a malleable metal rod covered with a clear plastic sheath (called a stylet). However, another intubation aid, a bougie (also named a gum elastic bougie or endotracheal tube introducer), was also introduced in the clinical setting to improve the efficacy of conventional ETI.METHODS: This study performed a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of bougie and stylet approaches in ETI. PubMed, Embase, and Cochrane Library databases were searched for studies published before November 2018. Randomized controlled trials comparing the clinical outcomes of bougie and stylet approaches in patients who underwent orotracheal intubation were included. Meta-analyses were conducted by using a random effects model, and treatment efficacy was measured by evaluating the first-attempt success rate and intubation duration.RESULTS: A total of 5 randomized controlled trials and 1,038 patients were included. Although a bougie resulted in a better first-attempt success rate, no significant difference was observed between the approaches (risk ratios, 1.03; 95{\%} confidence interval, 0.85-1.24). Moreover, no significant differences were observed in the intubation duration and esophageal intubation rate between the bougie and stylet approaches.CONCLUSION: Endotracheal intubation performed with a bougie was not superior over ETI performed with a stylet. Therefore, intubation approaches should be selected by considering personal preference and clinician expertise.LEVEL OF EVIDENCE: Systematic review and meta-analysis, level II.",
keywords = "Endotracheal intubation, bougie, endotracheal tube introducer, orotracheal intubation, stylet",
author = "Yu-Jia Sheu and Sung-Wei Yu and Tsai-Wei Huang and Feng-Lin Liu and Yen-Kuang Lin and Ka-Wai Tam",
year = "2019",
month = "5",
day = "1",
doi = "10.1097/TA.0000000000002216",
language = "English",
volume = "86",
pages = "902--908",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Comparison of the Efficacy of A Bougie and Stylet in Patients With Endotracheal Intubation

T2 - A Meta-Analysis of Randomized Controlled Trials

AU - Sheu, Yu-Jia

AU - Yu, Sung-Wei

AU - Huang, Tsai-Wei

AU - Liu, Feng-Lin

AU - Lin, Yen-Kuang

AU - Tam, Ka-Wai

PY - 2019/5/1

Y1 - 2019/5/1

N2 - BACKGROUND: Endotracheal intubation (ETI) is a procedure widely performed for several clinical indications. In typical ETI, an endotracheal tube is placed into a patient's trachea with the help of a malleable metal rod covered with a clear plastic sheath (called a stylet). However, another intubation aid, a bougie (also named a gum elastic bougie or endotracheal tube introducer), was also introduced in the clinical setting to improve the efficacy of conventional ETI.METHODS: This study performed a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of bougie and stylet approaches in ETI. PubMed, Embase, and Cochrane Library databases were searched for studies published before November 2018. Randomized controlled trials comparing the clinical outcomes of bougie and stylet approaches in patients who underwent orotracheal intubation were included. Meta-analyses were conducted by using a random effects model, and treatment efficacy was measured by evaluating the first-attempt success rate and intubation duration.RESULTS: A total of 5 randomized controlled trials and 1,038 patients were included. Although a bougie resulted in a better first-attempt success rate, no significant difference was observed between the approaches (risk ratios, 1.03; 95% confidence interval, 0.85-1.24). Moreover, no significant differences were observed in the intubation duration and esophageal intubation rate between the bougie and stylet approaches.CONCLUSION: Endotracheal intubation performed with a bougie was not superior over ETI performed with a stylet. Therefore, intubation approaches should be selected by considering personal preference and clinician expertise.LEVEL OF EVIDENCE: Systematic review and meta-analysis, level II.

AB - BACKGROUND: Endotracheal intubation (ETI) is a procedure widely performed for several clinical indications. In typical ETI, an endotracheal tube is placed into a patient's trachea with the help of a malleable metal rod covered with a clear plastic sheath (called a stylet). However, another intubation aid, a bougie (also named a gum elastic bougie or endotracheal tube introducer), was also introduced in the clinical setting to improve the efficacy of conventional ETI.METHODS: This study performed a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of bougie and stylet approaches in ETI. PubMed, Embase, and Cochrane Library databases were searched for studies published before November 2018. Randomized controlled trials comparing the clinical outcomes of bougie and stylet approaches in patients who underwent orotracheal intubation were included. Meta-analyses were conducted by using a random effects model, and treatment efficacy was measured by evaluating the first-attempt success rate and intubation duration.RESULTS: A total of 5 randomized controlled trials and 1,038 patients were included. Although a bougie resulted in a better first-attempt success rate, no significant difference was observed between the approaches (risk ratios, 1.03; 95% confidence interval, 0.85-1.24). Moreover, no significant differences were observed in the intubation duration and esophageal intubation rate between the bougie and stylet approaches.CONCLUSION: Endotracheal intubation performed with a bougie was not superior over ETI performed with a stylet. Therefore, intubation approaches should be selected by considering personal preference and clinician expertise.LEVEL OF EVIDENCE: Systematic review and meta-analysis, level II.

KW - Endotracheal intubation

KW - bougie

KW - endotracheal tube introducer

KW - orotracheal intubation

KW - stylet

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U2 - 10.1097/TA.0000000000002216

DO - 10.1097/TA.0000000000002216

M3 - Review article

VL - 86

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JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

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