Abstract
Background: Endotracheal intubation is a vital procedure in emergency airway management, particularly among patients with difficult airways. Bougie-assisted and stylet-assisted intubation techniques are commonly used; however, their comparative effectiveness in emergency difficult airway management requires further evaluation.
Objective: This study aimed to compare the first-pass success rate of bougie-assisted versus styletted endotracheal tube intubation among patients with difficult airways undergoing emergency endotracheal intubation. Secondary outcomes included intubation duration, complications, and changes in vital signs.
Methods: This randomized controlled trial included 102 patients with difficult airways requiring emergency endotracheal intubation. Patients were randomly allocated into two equal groups: the bougie group (n = 51) and the styletted endotracheal tube group (n = 51). The primary outcome was successful intubation on the first attempt. Secondary outcomes included intubation duration, desaturation, esophageal intubation, systolic blood pressure, heart rate, and oxygen saturation. Categorical variables were analyzed using the chi-square test, while continuous variables were analyzed using the independent-samples t-test or paired-samples t-test, as appropriate. A p-value < 0.05 was considered statistically significant.
Results: First-pass intubation success was achieved in 47 patients (92.15%) in the bougie group and 39 patients (76.47%) in the styletted endotracheal tube group. The bougie group demonstrated a significantly higher first-pass success rate than the styletted endotracheal tube group (χ² = 4.74, p = 0.029). Intubation duration did not differ significantly between groups. Complication rates were low in both groups, with no statistically significant difference in desaturation or esophageal intubation. Systolic blood pressure showed a statistically significant post-intubation change, while heart rate and oxygen saturation changes were not statistically significant.
Conclusion: Bougie-assisted intubation demonstrated a significantly higher first-pass success rate compared with styletted endotracheal tube intubation among patients with difficult airways undergoing emergency endotracheal intubation. Both techniques were generally safe, with low complication rates. Bougie-assisted intubation may be preferred in difficult airway situations to improve first-attempt success, depending on clinician experience and equipment availability.