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Copyright (c) 2023 Tong Yin Kuan, Abdul Hadi Mohamed
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Abstract
Introduction: Both video laryngoscopes and bougies play major role in difficult airway management. Even when a video laryngoscope is available to improve intubation view, there are instances when the vocal cords are visible, but intubation cannot be achieved. In these cases, bougies have a role in assisting intubation. This study aimed to compare the efficacy of the Flexible Tip Bougie with others in simulated difficult intubation.
Methods: This study was designed as a randomized, cross-over, simulation manikin study. It involved 42 medical officers from the Department of Anaesthesiology. In the study, participants performed intubation under simulated difficult airway conditions. Three types of bougie were used by each participant in random order: (1) Flexible Tip Bougie, (2) Portex Single-Use Introducer, and (3) Frova Intubating Introducer.
Results: The intubation success rate was 100% for the Flexible Tip Bougie, 78.6% for the Frova Intubating Introducer, and only 50% for the Portex Single-Use Introducer (p < 0.001). The median intubation time was shortest with the Flexible Tip Bougie, at 16.08 s (interquartile range [IQR]: 6.13); 18.25 s (IQR: 18.07) with Frova, and 19.39 s (IQR: 37.60) with Portex (p = 0.449). The ease of use was lowest with Portex (69.64, standard deviation [SD]: 32.45), average with Frova (50.59, SD: 29.98), and highest with Flexible Tip (16.67, SD: 21.86; [p < 0.001]).
Conclusion: In this manikin study, the Flexible Tip Bougie was more efficient in achieving successful intubation and easier to use than the Portex and Frova introducers in a difficult intubation scenario.
References
Heinrich S, Birkholz T, Irouschek A, Ackermann A, Schmidt J. Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia. J Anesth. 2013;27(6):815–21. https://doi.org/10.1007/s00540-013-1650-4
Cook TM, MacDougall-Davis SR. Complications and failure of airway management. Br J Anaesth. 2012 Dec;109(1 Suppl):I68–85. https://doi.org/10.1093/bja/aes393
Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827–48. https://doi.org/10.1093/bja/aev371
Ministry of Health Malaysia [Internet]. National Audit on Anaesthetic Airway Management; [cited 2022 Dec 22]. Available from: http://www.moh.gov.my/index.php/pages/view/1131
Lascarrou JB, Boisrame-Helms J, Bailly A, et al. Video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients: a randomized clinical trial. JAMA. 2017;317(5):483–93. https://doi.org/10.1001/jama.2016.20603
Angadi SP, Frerk C. Videolaryngoscopy and Cormack and Lehane grading. Anaesth. 2011;66(7):628–9. https://doi.org/10.1111/j.1365-2044.2011.06777.x
Vowles BJ, Rodda B, Ringrose D. Evaluation of intubating adjuncts to videolaryngoscopy in a simulated difficult airway: a manikin cross-over study. Anaesth Intensive Care. 2021;49(4):327–9. https://doi.org/10.1177/0310057X211012275
Brunckhorst TL, Grimmett W, Mun-San Kwan MM. Evaluation of a new bougie design for the difficult airway: a manikin crossover trial. Anaesth Intensive Care. 2018 Sep;46(5):544–5. Cited in: PubMed; PMID 30189828.
Frass M, Smereka J, Ruetzler K, Szarpak L, Robak O. New Flexible Tip Bougie catheter for difficult airway intubation: a randomized, crossover pilot study. Disaster Emerg Med J. 2019;4(2):50–4. https://doi.org/10.5603/DEMJ.2019.0010
Mahli N, Md Zain J, Mohamad Mahdi SN, et al. The performance of Flexible Tip Bougie™ in intubating simulated difficult airway model. Front Med. 2021 May 7;8:[6 p.]. https://doi.org/10.3389/fmed.2021.677626
Cormack J, Langley B, Bhanabhai LR, Kluger R. A randomised crossover comparison of two endotracheal tube introducers: the FROVA and the Flexible Tip Bougie for GlideScope intubation of a difficult airway manikin by infrequent intubators. Int J Emerg Med. 2020 Jul 17;13(1):[7 p.]. https://doi.org/10.1186/s12245-020-00298-6
Machin D, Campbell M, Fayers PM, Pinol A. Sample size tables for clinical studies [Internet]. 2nd ed. New Jersey: Wiley-Blackwell; 1997 Jan [cited 2019 Apr 10]. Available from: https://books.google.com.my/books?id=zPQhQ8d-4JwC
The R Project for Statistical Computing [Internet]. Austria: R Core Team; [cited 2019 Nov 1]. Available from: https://www.r-project.org/
Evrin T, Smereka J, Gorczyca D, et al. Comparison of different intubation methods in difficult airways during simulated cardiopulmonary resuscitation with continuous chest compression: a randomized cross-over manikin trial. Emerg Med Int. 2019:[7 p.]. https://doi.org/10.1155/2019/7306204
Batuwitage B, McDonald A, Nishikawa K, Lythgoe D, Mercer S, Charters P. Comparison between bougies and stylets for simulated tracheal intubation with the C-MAC D-blade videolaryngoscope. Eur J Anaesthesiol. 2015;32(6):400–5. https://doi.org/10.1097/EJA.0000000000000070