Introduction: Endotracheal intubation is a high-risk procedure that can be lifesaving for critically ill or injured patients. Assisted devices, such as the bougie and stylet, are commonly used to improve success rates and reduce complications. The bougie facilitates the passage of the endotracheal tube through the vocal cords while the stylet is inserted into the endotracheal tube prior to intubation. However, there is variation in clinical practice regarding the preference for using these devices in difficult airway management. Methods: This systematic review and meta-analysis included randomized controlled trials (RCTs) that compared the efficacy of bougie versus stylet in tracheal intubation. Medline, Embase, Cochrane Central of Controlled Trials, and Clinical trials.gov were searched for studies discussing the same topic. The primary outcome was the first-attempt intubation success rate between the bougie and stylet. Our secondary outcomes were to compare the duration of intubation and the complication rates between bougie and stylet. Results: A total of 7 RCTs that enrolled participants (number) were eligible. The bougie approach had a slightly higher success rate on the first attempt, but there was no significant difference between the method’s risk ratio (RR, 1.01; 95% CI, 0.90–1.15). The duration of intubation, pooled analysis indicated a statistically significant reduction in the duration of intubation with the stylet approach compared to the bougie approach (MD, 8.39; 95% CI, 2.87–13.91). Subgroup analysis revealed lower rates of esophageal intubation (RR, 0.65; 95% CI, 0.26–1.61, I2 = 0%) and pneumothorax (RR, 0.94; 95% CI, 0.54–1.66, I2 = 0%) in the bougie group. Conclusion: This study reported that no significant difference between the use of bougie versus stylet in terms of first-attempt intubation success rates and the complication rates of endotracheal intubation. However, sty let displayed a significantly shorter duration of intubation in comparison to bougie.

Keywords: Endotracheal intubation, tracheal intubation, bougie, gum elastic bougie, stylet.