Taboada, ManuelCariñena Amigo, AgustínEstany-Gestal, AnaDe Miguel, ManuelaIraburu, RocíoAlonso, SaraGarcía, FátimaDos Santos, LauraEiras, MaríaSelas, SaloméMartínez, AdriánTubío, AnaCampaña, OlgaDíaz-Vieito, M.Alcántara, Jorge MiguelÁlvarez Escudero, JuliánSeoane-Pillado, Teresa2025-10-162025-10-162025-06-17Taboada M, Cariñena A, Estany-Gestal A, de Miguel M, Iraburu R, Alonso S, García F, Dos Santos L, Eiras M, Selas S, Martínez A, Tubio A, Campaña O, Diaz-Vieito M, Alcántara JM, Alvarez J, Seoane-Pillado T. Flexible-tip bougie vs. stylet for tracheal intubation with a hyperangulated videolaryngoscope in critical care: a randomised controlled trial. Anaesthesia. 2025 Jul;80(7):790-798.0003-2409https://hdl.handle.net/2183/45998Randomized controlled trial[Abstract] Introduction: The optimal introducer for tracheal intubation with a hyperangulated blade videolaryngoscope for patients in the ICU remains uncertain. Both stylets and flexible-tip bougies have been used, yet there is limited evidence on which is more efficacious. Methods: We conducted a randomised controlled trial comparing flexible-tip bougie vs. stylet using a hyperangulated blade videolaryngoscope (C-MAC® D-blade). Adults admitted to the ICU who required tracheal intubation were included. Primary outcome was first-attempt tracheal intubation success. Secondary outcomes included the number of tracheal intubation attempts; tracheal intubation difficulty; and incidence of complications. Results: A total of 140 patients were allocated randomly (40 female (29%); mean (SD) age 68 (13.0) y). First-attempt tracheal intubation success was higher in patients allocated to flexible-tip bougie (69/70, 99%) compared with stylet (58/70 (83%), p = 0.005). The proportion of patients' tracheas intubated in one, two or three attempts was 69/70 (99%), 1/70 (1%) and 0/70 (0%) in the flexible-tip bougie group, compared with 58/70 (83%), 7/70 (10%), and 5/70 (7%) in the stylet group, respectively. More patients in the stylet group required laryngeal manipulation (22/70 (31.4%)) during tracheal intubation compared with the flexible-tip group (7/70 (10%)). Anaesthetists rated 69/70 (99%) of tracheal intubations with the flexible-tip bougie as not difficult or slightly difficult compared with 63/70 (90%) for the stylet group. No significant difference in the incidence of complications was observed between the two techniques. Discussion: In the ICU, first-attempt tracheal intubation success with a hyperangulated blade videolaryngoscope was higher using the flexible-tip bougie than the stylet. No differences were observed in operator difficulty or complication rates between the two techniques.engThis is the peer reviewed version of the article, which has been published in final form at https://doi.org/10.1111/anae.16574. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Airway managementBougieStyletTracheal intubationVideolaryngoscopy.journal articleembargoed access10.1111/anae.16574