Lit Matters #3: Bougie or Stylet? Master Both

First-pass intubation success in critically ill adults was similar with a bougie or a standard stylet in a large multicenter randomized trial. The practical airway lesson is not device loyalty but competence with both techniques when urgent ED and ICU intubation gets difficult.

Bougie Versus Stylet Intubation

• Equivalent first-pass success: A 1,106-patient multicenter RCT found no meaningful difference in first-attempt intubation success between bougie and stylet, reinforcing that either approach can work in critically ill adults.
• Real-world airway mix: About 40% of patients had at least one difficult-airway predictor, making this a pragmatic test of common high-stakes intubations rather than an idealized elective airway study.
• Video laryngoscopy context: Video laryngoscopy with a standard-geometry blade was used in roughly three quarters of cases, so the findings mainly reflect modern VL practice rather than universal direct laryngoscopy.
• Procedure time signal: Median time to intubation was slightly longer with bougie than stylet, a useful reminder that familiarity and setup matter when seconds count. We get into the bedside implications in the episode.
• Important trial limits: Open-label design and exclusion of cases where operators felt one device was required make the results less applicable to the obviously difficult airways where technique preference matters most.
• Practical airway takeaway: The headline conclusion is to master both bougie and stylet, because first-pass success depends less on device tribalism than on operator skill, patient selection, and rescue readiness.