Comparison of Time for Endotracheal Intubation with Flexible Tip Bougie Versus Standard Bougie During Videolaryngoscopy in Simulated Cervical Spine Immobilization in Adult Patients - A Randomized Control Trial.

BACKGROUND

We compared the time for successful endotracheal intubation with flexible-tip bougie (FTB) versus standard bougie (SB) during videolaryngoscopy in adults with simulated cervical spine immobilization.

METHODS

Seventy-six adult patients were allocated and randomized into the FTB Group and SB Group for intubation. After administration of general anaesthesia and muscle relaxant, the trachea was intubated with either FTB or SB using a CMAC videolaryngoscope Macintosh blade. The primary outcome was a comparison of the time required for successful tracheal intubation with FTB and SB during videolaryngoscopy in simulated cervical spine stabilization with cervical collar in adult patients. Secondary outcomes were best glottic view time, intubation attempts, ease of mouth opening, bougie insertion, intubation, and railroading of endotracheal tube (ETT), maneuvers, and complications.

RESULTS

Median [interquartile range (IQR)] total intubation time was comparable between FTB Group 29.6 (25.1-35.5) seconds and SB Group 33.3 (26.7-45.2) seconds; (p = 0.37). First-attempt intubation success was comparable in FTB Group 36 (97.3%) and SB Group 33 (86.8%) (p = 0.325). The median (IQR) bougie insertion time was significantly shorter in the FTB Group vs. the SB Group [5.23 (3.79-7.07) vs. 6.15 (3.91-8.6) seconds; p = 0.048]. Moderate to severe difficult bougie insertion was observed in significantly more patients in the SB Group vs. the FTB Group (10.6% vs. 0%; p = 0.004). Time for best gottic view, railroading ETT, bougie removal, manoeuvres, and complications were comparable.

CONCLUSION

FTB and SB guided total intubation time and number of intubation attempts with CMAC videolaryngoscope by the experienced anesthesiologists were comparable in simulated cervical spine stabilization. However, FTB insertion was significantly easier and shorter than SB insertion.

TRIAL REGISTRATION: Clinical Trials Registry- India (ICMR-NIMS)- CTRI/2021/04/032512 REGISTRATION LINK: https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid = NTA2NTc=&Enc=&userName=.