Comparison of time for endotracheal intubation with flexible tip bougie versus standard bougie during videolaryngoscopy in simulated cervical spine immobilization in adult patients - A randomized control trial.
Shivam Shivam, Renu Sinha, Bikash Ranjan Ray et al.
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In 30 seconds
This randomized controlled trial compared flexible-tip and standard bougies for endotracheal intubation using a CMAC videolaryngoscope in 76 adults under general anaesthesia with simulated cervical spine immobilization. Median total intubation time did not differ significantly: 29.6 (25.1-35.5) s with the flexible-tip bougie versus 33.3 (26.7-45.2) s with the standard bougie (p = 0.37). Bougie insertion was shorter and rated easier with the flexible-tip device, while first-attempt success and other reported outcomes were comparable.
Key findings
- Median total intubation time was 29.6 (25.1-35.5) s with the flexible-tip bougie and 33.3 (26.7-45.2) s with the standard bougie (p = 0.37).
- Bougie insertion time was 5.23 (3.79-7.07) s versus 6.15 (3.91-8.6) s, respectively (p = 0.048).
- Moderate to severe difficulty with bougie insertion occurred in 10.6% with the standard bougie and 0% with the flexible-tip bougie (p = 0.004).
- First-attempt success was comparable: 36 (97.3%) with the flexible-tip bougie and 33 (86.8%) with the standard bougie (p = 0.325).
Why it matters
In simulated cervical immobilization, the flexible-tip bougie made bougie placement faster and easier, but this did not translate into a demonstrated reduction in overall intubation time. The distinction is clinically relevant because device handling and total procedure performance are separate outcomes; the trial supports considering both when evaluating airway adjuncts in this setting.
What to keep in mind
The study involved simulated cervical spine immobilization and intubations performed by experienced anesthesiologists, so its findings may not generalize to actual cervical injury or less experienced operators.