First-Pass Intubation Is Similarly Successful with Stylet or Bougie

Most intubations in the emergency department and intensive care unit are done using a malleable stylet within an endotracheal tube (ETT). The stylet helps guide the ETT through the vocal cords. An alternative approach, usually reserved for difficult airways, is to pass a tracheal tube introducer (or “bougie”) through the vocal cords and then slide an ETT over the bougie.

Investigators randomized more than 1000 patients from 15 U.S. sites (7 emergency departments and 8 intensive care units) to a first-pass intubation approach of either stylet or bougie. Altered mental status and respiratory failure were the most common reasons for intubation. The clinicians performing the procedures had a median experience of 60 intubations with a median of 1…