Bougie Improves ETT First-Pass Success

July 10, 2017

I like to say “bougie”
The bougie is rarely used as a primary intubating device, rather as an adjunct when glottic visualization is difficult.  But in this retrospective study of around 500 intubations, it was used 80% of the time and improved first-pass success in placing the ETT (95%) compared to no bougie (86%).  However, it took 14 seconds longer to pass the tube and a greater percentage had hypoxia in the bougie group.  Apparently, they use the bougie for almost all intubations and are very experienced with it, so this single-center study may exaggerate the effectiveness of bougie use.  This is provocative, but I’m not ready to start using the bougie primarily vs as an adjunct for ED intubation.  We would need a multi-center RCT to know for certain if it’s beneficial or harmful.

Spoon Feed
Bougie use was associated with improved first-pass success in this single-center study.  But 80% in this group used it primarily and not as an adjunct, which doesn’t represent common practice.  Anand Swaminathan weighs in on this article on Life in the Fast Lane.

Source
The Bougie and First-Pass Success in the Emergency Department.  Ann Emerg Med. 2017 Jun 7. pii: S0196-0644(17)30509-7. doi: 10.1016/j.annemergmed.2017.04.033. [Epub ahead of print]

Peer reviewed by Thomas Davis.