Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial
Abstract Background Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. W...
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doaj-c7b1513e44f84d03bc84e8dcc6229b1d2020-11-25T03:17:08ZengBMCBMC Anesthesiology1471-22532020-04-0120111010.1186/s12871-020-01009-7Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trialKurt Ruetzler0Jacek Smereka1Cristian Abelairas-Gomez2Michael Frass3Marek Dabrowski4Szymon Bialka5Hanna Misiolek6Tadeusz Plusa7Oliver Robak8Olga Aniolek9Jerzy Robert Ladny10Damian Gorczyca11Sanchit Ahuja12Lukasz Szarpak13Departments of Outcomes Research and General Anesthesia, Cleveland Clinic, Anesthesiology InstituteDepartment of Emergency Medical Service, Wroclaw Medical UniversityCLINURSID Research Group, University of Santiago de CompostelaDepartment of Internal Medicine I, Medical University of ViennaChair and Department of Medical Education, Poznan University of Medical SciencesDepartment of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of SilesiaDepartment of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of SilesiaMedical Faculty, Lazarski UniversityDepartment of Internal Medicine I, Medical University of ViennaPolish Society of Disaster MedicineDepartment of Emergency Medicine, Medical University BialystokPolish Society of Disaster MedicineDepartment of Anesthesia, Henry Ford Health SystemPolish Society of Disaster MedicineAbstract Background Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization. Conclusion In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. Trial registration clinicaltrials.gov Identifier: NCT03733158 . 7th November 2018.http://link.springer.com/article/10.1186/s12871-020-01009-7Airway managementEndotracheal intubationMedical simulationBougie catheter |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kurt Ruetzler Jacek Smereka Cristian Abelairas-Gomez Michael Frass Marek Dabrowski Szymon Bialka Hanna Misiolek Tadeusz Plusa Oliver Robak Olga Aniolek Jerzy Robert Ladny Damian Gorczyca Sanchit Ahuja Lukasz Szarpak |
spellingShingle |
Kurt Ruetzler Jacek Smereka Cristian Abelairas-Gomez Michael Frass Marek Dabrowski Szymon Bialka Hanna Misiolek Tadeusz Plusa Oliver Robak Olga Aniolek Jerzy Robert Ladny Damian Gorczyca Sanchit Ahuja Lukasz Szarpak Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial BMC Anesthesiology Airway management Endotracheal intubation Medical simulation Bougie catheter |
author_facet |
Kurt Ruetzler Jacek Smereka Cristian Abelairas-Gomez Michael Frass Marek Dabrowski Szymon Bialka Hanna Misiolek Tadeusz Plusa Oliver Robak Olga Aniolek Jerzy Robert Ladny Damian Gorczyca Sanchit Ahuja Lukasz Szarpak |
author_sort |
Kurt Ruetzler |
title |
Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial |
title_short |
Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial |
title_full |
Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial |
title_fullStr |
Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial |
title_full_unstemmed |
Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial |
title_sort |
comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2020-04-01 |
description |
Abstract Background Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization. Conclusion In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. Trial registration clinicaltrials.gov Identifier: NCT03733158 . 7th November 2018. |
topic |
Airway management Endotracheal intubation Medical simulation Bougie catheter |
url |
http://link.springer.com/article/10.1186/s12871-020-01009-7 |
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