UMEM Educational Pearls

The BOUGIE Trial

  • More than 1 million patients undergo endotracheal intubation each year in the US.
  • Up to 20% of intubations fail on the first attempt, thereby increasing the risk of adverse outcome.
  • Over the past several years, many have become comfortable using the bougie as a rescue device when the first attempt at intubation fails with an endotracheal tube with stylet.
  • In contrast to its use as a rescue device, should the bougie be used during the first attempt rather than an endotracheal tube with a malleable stylet?
  • The BOUGIE Trial compared the effect of using the bougie to an endotracheal tube with stylet on first attempt success in critically ill patients.
  • The trial enrolled 1106 patients in 7 EDs and 8 ICUs at 11 hospitals.
  • The primary outcome of first pass success was not statistically different between those randomized to bougie and those randomized to endotracheal tube with stylet for the first attempt at intubation.. 
  • Though the trial did not find a statistical difference in first pass success rates, the bougie remains an important device in our management of the critically ill airway.


Driver BE, et al. Effect of use of a bougie vs endotracheal tube with stylet on successful intubation on the first attempt among critically ill patients undergoing tracheal intubation. JAMA. 2021. Published online December 8, 2021