Dynamic versus standard bougies for tracheal intubation with direct or indirect laryngoscopy in simulated or real scenarios: a systematic review and meta-analysis.

Introduction: This systematic review and meta-analysis aimed to compare the efficacy of dynamic versus standard bougies to achieve tracheal intubation.

Methods: We searched MEDLINE, Embase, CENTRAL, Web of Science, Scopus and Google Scholar on 10 October 2023. We included clinical trials comparing both devices. The primary outcome was the first-attempt intubation success rate. The secondary outcome was the time required for tracheal intubation.

Results: Eighteen studies were included. Dynamic bougies do not increase first-attempt success rate (RR 1.11;  = 0.06) or shorten tracheal intubation time (MD -0.30 sec;  = 0.84) in clinical trials in humans. In difficult airways, first-attempt success intubation rate was greater for dynamic bougies (RR 1.17;  = 0.002); Additionally, they reduced the time required for intubation (MD -4.80 sec;  = 0.001). First-attempt intubation success rate was higher (RR 1.15;  = 0.01) and time to achieve intubation was shorter when using Macintosh blades combined with dynamic bougies (MD -5.38 sec;  < 0.00001). Heterogeneity was high.

Conclusion: Dynamic bougies do not increase the overall first-pass success rate or shorten tracheal intubation time. However, dynamic bougies seem to improve first-attempt tracheal intubation rate in patients with difficult airways and in those intubated with a Macintosh blade. Further research is needed for definitive conclusions.

Registration Of Prospero: CRD42023472122.