BEAM

Bougie Use in Emergency Airway Management

Doente / População Intervenção / Exposição Comparação Desfecho

In757 adults undergoing emergency orotracheal intubation, abougieimprovedfirst-attempt intubation successcompared with anendotracheal tube plus stylet.

757

Desenho

Single-centre, unblinded, randomised clinical trial in an urban academic US emergency department (Hennepin County Medical Center), September 2016 to August 2017; 757 adults undergoing emergency orotracheal intubation with a Macintosh blade randomised to bougie (n=381) or endotracheal tube + stylet (n=376); adherence to the assigned device 98% vs 92%.

Desfecho

First-attempt intubation success in the prespecified subgroup with at least one difficult airway characteristic (body fluids obscuring the laryngeal view, airway obstruction or oedema, obesity, short neck, small mandible, large tongue, facial trauma or cervical spine immobilisation); n=380.

ResultadoFirst-attempt success in the difficult-airway subgroup 191/198 (96%) with bougie vs 150/182 (82%) with stylet, absolute difference 14% (95% CI 8% to 20%); among all patients 98% vs 87%, difference 11% (95% CI 7% to 14%). Median first-attempt duration 38 s vs 36 s and hypoxaemia 13% vs 14% did not differ; oesophageal intubation 0 vs 3 (1%); pneumothorax after intubation 9 (2%) per group.

Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179-2189. 10.1001/jama.2018.6496