• Samir Jaber, Amélie Rollé, Thomas Godet, Nicolas Terzi, Béatrice Riu, Pierre Asfar, Jeremy Bourenne, Séverin Ramin, Virginie Lemiale, QuenotJean-PierreJPDepartment of Intensive Care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000, Dijon, France.Lipness Team, Inserm Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, 21000, Dijon, France.Inserm CI, Christophe Guitton, Eloi Prudhomme, Cyril Quemeneur, Raiko Blondonnet, Mathieu Biais, Laurent Muller, Alexandre Ouattara, Martine Ferrandiere, Piehr Saint-Léger, Thomas Rimmelé, Julien Pottecher, Gerald Chanques, Fouad Belafia, Claire Chauveton, Helena Huguet, Karim Asehnoune, Emmanuel Futier, Elie Azoulay, Nicolas Molinari, Audrey De Jong, and STYLETO trial group.
• Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France. s-jaber@chu-montpellier.fr.
• Intensive Care Med. 2021 Jun 1; 47 (6): 653-664.

PurposeThe effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.MethodsIn this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.ResultsA total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4-12.1; relative risk, 1.10; 95%CI 1.02-1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, - 1.5; 95%CI - 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83-1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, - 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59-2.06. P = 0.76).ConclusionsAmong critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success.

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