2025/03/30 by Manuel Taboada, Agustín Cariñena, Ana Estany‐Gestal +14 · 1 voice · 2 citations
Medicine · #Airway Management and Intubation Techniques #Anesthesia and Sedative Agents #Nosocomial Infections in ICU
paper · pdf · doi:10.1111/anae.16574
openalex publication_date 2025/03/30 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/04
INTRODUCTION: The optimal introducer for tracheal intubation with a hyperangulated blade videolaryngoscope for patients in the ICU remains uncertain. Both stylets and flexible-tip bougies have been used, yet there is limited evidence on which is more efficacious. METHODS: D-blade). Adults admitted to the ICU who required tracheal intubation were included. Primary outcome was first-attempt tracheal intubation success. Secondary outcomes included the number of tracheal intubation attempts; tracheal intubation difficulty; and incidence of complications. RESULTS: A total of 140 patients were allocated randomly (40 female (29%); mean (SD) age 68 (13.0) y). First-attempt tracheal intubation success was higher in patients allocated to flexible-tip bougie (69/70, 99%) compared with stylet (58/70 (83%), p = 0.005). The proportion of patients' tracheas intubated in one, two or three attempts was 69/70 (99%), 1/70 (1%) and 0/70 (0%) in the flexible-tip bougie group, compared with 58/70 (83%), 7/70 (10%), and 5/70 (7%) in the stylet group, respectively. More patients in the stylet group required laryngeal manipulation (22/70 (31.4%)) during tracheal intubation compared with the flexible-tip group (7/70 (10%)). Anaesthetists rated 69/70 (99%) of tracheal intubations with the flexible-tip bougie as not difficult or slightly difficult compared with 63/70 (90%) for the stylet group. No significant difference in the incidence of complications was observed between the two techniques. DISCUSSION: In the ICU, first-attempt tracheal intubation success with a hyperangulated blade videolaryngoscope was higher using the flexible-tip bougie than the stylet. No differences were observed in operator difficulty or complication rates between the two techniques.