New Flexible Tip Bougie catheter for difficult airway intubation. A randomized, crossover pilot study

Abstract

INTRODUCTION: The ability to protect the airway is one of the basic skills that medical staff should have, especially those working within the Emergency Medical Service or Emergency Department. Endotracheal intubation under medical emergency conditions based on direct laryngoscopy is not effective enough; this effect is additionally reduced in the case of the difficult airway resulting from reduced visibility of the entrance to the glottis due to tongue or epiglottis oedema, trauma, etc. The aim of the study was to compare the intubation time and its effectiveness using two different stylets for difficult airway intubation. MATERIAL AND METHODS: The study involved 37 nurses who participated in training on advanced life support procedures. The experiment was designed as a randomized, cross-over simulation study. During the training, participants were instructed to perform endotracheal intubation using the tested intubation methods and had 20 minutes of practical training during which they were able to intubate with the tested stylets under normal airway. In the study, participants performed endotracheal intubation using a laryngoscope with a Macintosh blade and a difficult airway Bougie stylet (ONTEX, Chennai, India), or the Flexible Tip Bougie (MDSS GmbH, Hannover, Germany), which was designed to allow to guide the distal end of the anteriorly and posteriorly to facilitate entry into the larynx. RESULTS: The effectiveness of the first intubation attempt using a standard Bougie stylet was 37.8%, and that of the new Bougie stylet was 51.4% (p = 0.037). The mean intubation time was 55 s (IQR; 34–65) vs. 37 s (IQR; 25–41) (respectively, p = 0.021). The median ease of intubation was 7 (IQR; 5–9) points for a standard Bougie stylet and 5 (2.5–7) 2 points for a new Bougie stylet (p = 0.018). CONCLUSIONS: In a simulation study, the use of Flextip Bougie by nurses compared to a standard Bougie stylet was associated with higher efficacy and shorter intubation times in difficult airway.