Taboada Manuel, Cariñena Agustín, Estany-Gestal Ana, de Miguel Manuela, Iraburu Rocío, Alonso Sara, García Fátima, Dos Santos Laura, Eiras María, Selas Salomé, Martínez Adrián, Tubio Ana, Campaña Olga, Diaz-Vieito María, Alcántara Jorge Miguel, Alvarez Julián, Seoane-Pillado Teresa
Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Spain.
Research Methodology Unit, Fundación Instituto de Investigaciones Sanitarias, Santiago, Spain.
Anaesthesia. 2025 Jul;80(7):790-798. doi: 10.1111/anae.16574. Epub 2025 Mar 30.
The optimal introducer for tracheal intubation with a hyperangulated blade videolaryngoscope for patients in the ICU remains uncertain. Both stylets and flexible-tip bougies have been used, yet there is limited evidence on which is more efficacious.
We conducted a randomised controlled trial comparing flexible-tip bougie vs. stylet using a hyperangulated blade videolaryngoscope (C-MAC D-blade). Adults admitted to the ICU who required tracheal intubation were included. Primary outcome was first-attempt tracheal intubation success. Secondary outcomes included the number of tracheal intubation attempts; tracheal intubation difficulty; and incidence of complications.
A total of 140 patients were allocated randomly (40 female (29%); mean (SD) age 68 (13.0) y). First-attempt tracheal intubation success was higher in patients allocated to flexible-tip bougie (69/70, 99%) compared with stylet (58/70 (83%), p = 0.005). The proportion of patients' tracheas intubated in one, two or three attempts was 69/70 (99%), 1/70 (1%) and 0/70 (0%) in the flexible-tip bougie group, compared with 58/70 (83%), 7/70 (10%), and 5/70 (7%) in the stylet group, respectively. More patients in the stylet group required laryngeal manipulation (22/70 (31.4%)) during tracheal intubation compared with the flexible-tip group (7/70 (10%)). Anaesthetists rated 69/70 (99%) of tracheal intubations with the flexible-tip bougie as not difficult or slightly difficult compared with 63/70 (90%) for the stylet group. No significant difference in the incidence of complications was observed between the two techniques.
In the ICU, first-attempt tracheal intubation success with a hyperangulated blade videolaryngoscope was higher using the flexible-tip bougie than the stylet. No differences were observed in operator difficulty or complication rates between the two techniques.
对于重症监护病房（ICU）的患者，使用超角形镜片视频喉镜进行气管插管时，最佳引导工具仍不明确。管芯和软头探条均已被使用，但关于哪种更有效，证据有限。
我们进行了一项随机对照试验，比较使用超角形镜片视频喉镜（C-MAC D型镜片）时软头探条与管芯的效果。纳入了入住ICU且需要气管插管的成年人。主要结局是首次气管插管成功。次要结局包括气管插管尝试次数；气管插管难度；以及并发症发生率。
共随机分配了140例患者（40例女性（29%）；平均（标准差）年龄68（13.0）岁）。分配到软头探条组的患者首次气管插管成功率（69/70，99%）高于管芯组（58/70（83%），p = 0.005）。软头探条组一次、两次或三次尝试成功插入气管的患者比例分别为69/70（99%）、1/70（1%）和0/70（0%），而管芯组分别为58/70（83%）、7/70（10%）和5/70（7%）。与软头探条组（7/70（10%））相比，管芯组更多患者在气管插管期间需要进行喉部操作（22/70（31.4%））。麻醉医生将软头探条进行的69/70（99%）次气管插管评定为不难或稍有难度，而管芯组为63/70（90%）。两种技术在并发症发生率方面未观察到显著差异。
在ICU中，使用超角形镜片视频喉镜时，软头探条的首次气管插管成功率高于管芯。两种技术在操作难度或并发症发生率方面未观察到差异。
