Dynamic versus standard bougies for tracheal intubation with direct or indirect laryngoscopy in simulated or real scenarios: a systematic review and meta-analysis

ABSTRACT

Introduction

This systematic review and meta-analysis aimed to compare the efficacy of dynamic versus standard bougies to achieve tracheal intubation.

Methods

We searched MEDLINE, Embase, CENTRAL, Web of Science, Scopus and Google Scholar on 10 October 2023. We included clinical trials comparing both devices. The primary outcome was the first-attempt intubation success rate. The secondary outcome was the time required for tracheal intubation.

Results

Eighteen studies were included. Dynamic bougies do not increase first-attempt success rate (RR 1.11; p = 0.06) or shorten tracheal intubation time (MD −0.30 sec; p = 0.84) in clinical trials in humans. In difficult airways, first-attempt success intubation rate was greater for dynamic bougies (RR 1.17; p = 0.002); Additionally, they reduced the time required for intubation (MD −4.80 sec; p = 0.001). First-attempt intubation success rate was higher (RR 1.15; p = 0.01) and time to achieve intubation was shorter when using Macintosh blades combined with dynamic bougies (MD −5.38 sec; p < 0.00001). Heterogeneity was high.

Conclusion

Dynamic bougies do not increase the overall first-pass success rate or shorten tracheal intubation time. However, dynamic bougies seem to improve first-attempt tracheal intubation rate in patients with difficult airways and in those intubated with a Macintosh blade. Further research is needed for definitive conclusions.

Registration of PROSPERO

CRD42023472122

KEYWORDS:

• Airway management
• difficult airway
• tracheal intubation
• bougie
• stylet
• laryngoscopy

Article highlights

• There is currently insufficient evidence to state that dynamic bougies globally provide a better first-attempt intubation rate or a reduced time to achieve intubation compared with standard bougies.

• Dynamic bougies may be more useful than stylets as adjuvants for intubation with a Macintosh-type laryngoscope.

• Dynamic bougies may be more useful than stylets as adjuvants for intubation in patients with difficult airway.

• Further evaluation is necessary to confirm the precise role of these devices in the airway management.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Ethical approval

No ethics approval was needed because this is a systematic review of published studies. No personal, confidential, or sensitive material was collected from the participants in this study. All data used are in the public domain.

Authors’ contributions

José A. Sastre, Manuel A. Gómez-Rios and Teresa López contributed to the study conception and design. Material preparation and data collection were performed by José A. Sastre, Mánuel A. Gómez-Rios, Teresa López, Uxia Gutiérrez-Couto and Rubén Casans-Francés. Data analysis was performed by José A. Sastre, Teresa López y Rubén Casans-Francés. The first draft of the manuscript was written by José A. Sastre, Manuel Á. Goméz-Rios and Teresa López and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17434440.2024.2344667

Additional information

Funding

This paper was not funded.