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Comparison of the efficacy of a bougie and stylet in patients with endotracheal intubation

A meta-analysis of randomized controlled trials

Sheu, Yu-Jia, MS; Yu, Sung-Wei, MS; Huang, Tsai-Wei, PhD; Liu, Feng-Lin, MD, MSc; Lin, Yen-Kuang, PhD; Tam, Ka-Wai, MD, PhD

Journal of Trauma and Acute Care Surgery: May 2019 - Volume 86 - Issue 5 - p 902–908
doi: 10.1097/TA.0000000000002216

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.

METHODS This study performed a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of bougie and stylet approaches in ETI. PubMed, Embase, and Cochrane Library databases were searched for studies published before November 2018. Randomized controlled trials comparing the clinical outcomes of bougie and stylet approaches in patients who underwent orotracheal intubation were included. Meta-analyses were conducted by using a random effects model, and treatment efficacy was measured by evaluating the first-attempt success rate and intubation duration.

RESULTS A total of 5 randomized controlled trials and 1,038 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.

CONCLUSION Endotracheal intubation 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 II.

From the School of Medicine, College of Medicine (Y.-J.S., S.-W.Y.), School of Nursing, College of Nursing (T.-W.H., Y.-K.L.), Cochrane Taiwan (T.-W.H., K.-W.T.), Department of Anesthesiology (F.-L.L.), Shuang Ho Hospital, Department of Anesthesiology, School of Medicine (F,-L.L.), College of Medicine, Biostatistics Center (Y.-K.L.), Center for Evidence-Based Health Care (K.-W.T.), Shuang Ho Hospital, Division of General Surgery (K.-W.T.), Department of Surgery, School of Medicine, College of Medicine, and Division of General Surgery (K.-W.T.), Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.

Submitted: November 8, 2018, Revised: January 11, 2019, Accepted: January 23, 2019, Published online: February 8, 2019.

Address for reprints: Ka-Wai Tam, MD, PhD, Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan; email:

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© 2019 Lippincott Williams & Wilkins, Inc.