Should We Do Bougie First Intubation in Pediatrics?

April 14, 2023

Written by Christian Gerhart

Spoon Feed
The use of a bougie for pediatric intubation was not associated with increased first pass success or increased complication rates compared to an endotracheal tube (ETT) with a stylet at an academic emergency department where operators are facile with the bougie.    

Why does this matter?
There is some evidence that in adults, use of a bougie can increase first pass success for endotracheal intubation. The use of the bougie in pediatric populations has not been as well studied and could represent an alternative to the more commonly used ETT with stylet for pediatric intubation.   

You can have a bougie when you’re older…
This was a 10-year retrospective observational study of 195 pediatric patients (<18yo) at an academic ED (Hennepin County) where use of the bougie for the initial intubation attempt is common practice. Most intubations were performed by PGY3 Emergency Medicine residents. The primary outcome was first pass success, defined as confirmed placement of the ETT in the trachea with one laryngoscope blade insertion. 

When comparing a pediatric bougie to an ETT with stylet, they found that first pass success was not significantly different between the bougie (72%) and ETT with stylet (78%) groups, -6% difference (95%CI -19 to 6.0%). Of note, the bougie group had more difficult airway characteristics and was older (median age 5) compared to the ETT with stylet group (median age 1.7). There seemed to be a trend toward lower complication rates with the bougie group, though this was not statistically significant: 38% vs 51%, -13% difference (95%CI -27 to 2%).

Bottom Line: Although we cannot determine whether the bougie is superior to a styleted ETT based on this study, it does provide a helpful springboard for future studies. As with this group’s previous studies, there may be some generalizability limitations to centers where providers are not as familiar with bougie use.  

Source
The Pediatric Bougie for the First Tracheal Intubation Attempt in Critically Ill Children. Ann Emerg Med. 2023 Feb 23;S0196-0644(23)00030-6. doi: 10.1016/j.annemergmed.2023.01.016. Online ahead of print.

Reviewed by Aaron Lacy