Impact of Use of a Bougie vs Endotracheal Tube and Stylet on First-Try Intubation Success Amongst Sufferers With Tough Airways Present process Emergency Intubation: A Randomized Medical Trial.
JAMA. 2018 06 05;319(21):2179-2189
Authors: Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, Cleghorn MR, McGill JW, Cole JB
Significance: The tracheal tube introducer, generally known as the bougie, is usually used to assist tracheal intubation in poor laryngoscopic views or after intubation makes an attempt fail. The impact of routine bougie use on first-attempt intubation success is unclear.
Goal: To match first try intubation success facilitated by the bougie vs the endotracheal tube?+?stylet.
Design, Setting, and Sufferers: The Bougie Use in Emergency Airway Administration (BEAM) trial was a randomized scientific trial carried out from September 2016 via August 2017 within the emergency division at Hennepin County Medical Heart, an city, tutorial division in Minneapolis, Minnesota, the place emergency physicians carry out all endotracheal intubations. Included sufferers have been 18 years and older who have been consecutively admitted to the emergency division and underwent emergency orotracheal intubation with a Macintosh laryngoscope blade for respiratory arrest, issue respiration, or airway safety.
Interventions: Sufferers have been randomly assigned to bear the preliminary intubation try facilitated by bougie (n?=?381) or endotracheal tube?+?stylet (n?=?376).
Foremost Outcomes and Measures: The first final result was first-attempt intubation success in sufferers with not less than 1 troublesome airway attribute (physique fluids obscuring the laryngeal view, airway obstruction or edema, weight problems, brief neck, small mandible, massive tongue, facial trauma, or the necessity for cervical backbone immobilization). Secondary outcomes have been first-attempt success in all sufferers, first-attempt intubation success with out hypoxemia, first-attempt period, esophageal intubation, and hypoxemia.
Outcomes: Amongst 757 sufferers who have been randomized (imply age, 46 years; ladies, 230 [30%]), 757 sufferers (100%) accomplished the trial. Among the many 380 sufferers with not less than 1 troublesome airway attribute, first-attempt intubation success was greater within the bougie group (96%) than within the endotracheal tube?+?stylet group (82%) (absolute between-group distinction, 14% [95% CI, 8% to 20%]). Amongst all sufferers, first-attempt intubation success within the bougie group (98%) was greater than the endotracheal tube?+?stylet group (87%) (absolute distinction, 11% [95% CI, 7% to 14%]). The median period of the primary intubation try (38 seconds vs 36 seconds) and the incidence of hypoxemia (13% vs 14%) didn’t differ considerably between the bougie and endotracheal tube?+?stylet teams.
Conclusions and Relevance: On this emergency division, use of a bougie in contrast with an endotracheal tube?+?stylet resulted in considerably greater first-attempt intubation success amongst sufferers present process emergency endotracheal intubation. Nonetheless, these findings needs to be thought-about provisional till the generalizability is assessed in different establishments and settings.
Trial Registration: clinicaltrials.gov Identifier: NCT02902146.
PMID: 29800096 [PubMed – in process]