• Matthew E Prekker, Ashley R Bjorklund, Carrie Myers, Lauren Harvey, Gabriella B Horton, Jack Goldstein, Sarah C Usher, Robert F Reardon, Aaron Robinson, Ashley M Strobel, and Brian E Driver.
• Department of Emergency Medicine, Hennepin County Medical Center; Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hennepin County Medical Center. Electronic address: matthew.prekker@hcmed.org.
• Ann Emerg Med. 2023 Jun 1; 81 (6): 667676667-676.

Study ObjectiveBougie use during emergency tracheal intubation has not been well studied in children.MethodsThis was a 10-year observational study of pediatric intubations (<18 years of age) in the emergency department (ED) of an academic institution. Bougie training and use are standard in our ED, including for emergency medicine residents. Study data were collected by a combination of charts and video reviews. We compare first-attempt intubation success and procedural complications between pediatric patients with and without bougie use during tracheal intubation in the ED. In addition, we evaluate the independent association of bougie use with first-attempt intubation success using multivariable logistic regression.ResultsWe collected data on intubation success and bougie use for 195 pediatric patients over more than 10 years. On the first tracheal intubation attempt, a pediatric bougie was used in 126 patients (65%). Median patient age was 5 years (interquartile range 1.7 to 9) in the bougie group and 1.7 years (interquartile range 0.2 to 5) in the no bougie group. Intubation was successful on the first attempt in 72% of intubations with a bougie versus 78% without a bougie (absolute difference -6%, 95% confidence interval [CI] -19 to 6%); the adjusted odds of first-attempt success with a bougie were 0.54 (95% CI 0.24 to 1.19). A procedural complication occurred for 38% of patients in the bougie group versus 51% in the no bougie group (-13%, 95% CI -27% to 2%). Two neonates, one in each group, experienced a potential injury to the airway or lower respiratory tract.ConclusionIn an academic ED where the bougie is commonly used, bougie use in children was not associated with procedural success or complications. Our study suggests that a randomized clinical trial is needed to determine the effect of bougie use during emergency pediatric intubation.Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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