Comparison of the Efficacy of A Bougie and Stylet in Patients With Endotracheal Intubation: A Meta-Analysis of Randomized Controlled Trials

Background Endotracheal intubation (ETI) is a procedure widely performed for several clinical indications. In typical ETI, an endotracheal tube is placed into a patient’s trachea with the help of a malleable metal rod covered with a clear plastic sheath (called a “stylet”). However, another intubation aid, a bougie (also named a “gum elastic bougie” or “endotracheal tube introducer”), was also introduced in the clinical setting to improve the efficacy of conventional ETI. Objective To compare the efficacy of bougie and stylet approaches in ETI. Design A systematic review and meta-analysis of randomized controlled trials (RCTs). Data sources PubMed, Embase, and Cochrane Library databases were searched for studies published before November 2018. Eligibility criteria RCTs comparing the clinical outcomes of bougie and stylet approaches in patients who underwent orotracheal intubation were included. We conducted meta-analyses by using a random effects model. Treatment efficacy was measured by evaluating the first-attempt success rate and intubation duration. Results A total of 5 RCTs and 1038 patients were included. Although a bougie resulted in a better first-attempt success rate, no significant difference was observed between the approaches (risk ratios: 1.03, 95% confidence interval: 0.85-1.24). Moreover, no significant differences were observed in the intubation duration and esophageal intubation rate between the bougie and stylet approaches. Conclusions ETI performed with a bougie was not superior over ETI performed with a stylet. Therefore, intubation approaches should be selected by considering personal preference and clinician expertise. Level of evidence Systematic review and meta-analysis, level I. Address correspondence and reprint requests to: Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. Tel: 886-2-22490088 ext.8860. Fax: 886-2-22490088 ext.2507. E-mail: kelvintam@h.tmu.edu.tw (Ka-Wai Tam); E-mail: robbinlin@tmu.edu.tw (Yen-Kuang Lin) Yu-Jia Sheu and Sung-Wei Yu contributed equally to this work. Author Disclosure: The authors have no conflicts of interest or financial ties to disclose. Funding: The authors received no specific funding for this work. Acknowledgement: This manuscript was edited by Wallace Academic Editing. © 2019 Lippincott Williams & Wilkins, Inc.

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