Effect of Bougie-Guided Nasal Intubations upon Bleeding: A Randomised Controlled Trial

Bleeding due to inadvertent trauma is a troublesome complication of nasal intubations. A lot of methods have been suggested to minimise this problem. A flexible bougie can be passed atraumatically via the nasal route to the trachea and an appropriate-sized endotracheal tube can be railroaded over it to avoid this problem. The primary objective of the study was to compare the severity of bleeding with bougie-guided and conventional nasotracheal intubations on a subjective scale. The time taken for successful intubations and the number of attempts required were also noted.

This randomised controlled study was performed in 40 adult patients requiring nasotracheal intubations for various elective surgeries over a 3-month period in a teaching hospital. The patients after satisfying the inclusion criteria were randomised into two groups of 20 each: Bougie-guided (Group B) and Not Bougie-guided (Group NB). Group B patients were intubated by railroading the endotracheal tube over a flexible bougie, and Group NB patients were intubated conventionally without the bougie. The degree of bleeding was noted on a subjective scale as nil, mild, moderate or severe. The time taken for intubation in seconds and the number of attempts taken were noted. The degree of bleeding was compared using Mann-Whitney U test, and the time taken for intubation was compared using the Student's t test after assessing normalcy. An alpha error of 5% was used, and p values less than 0.05% were considered significant.

All patients randomised completed the study. The degree of bleeding was lesser in the Bougie-guided group than in the conventional group (p=0.02), and the time taken for intubation was longer in the bougie-guided group (p<0.01).

Using a bougie routinely for nasal intubations might minimise trauma during nasal intubations but increase the time taken for intubation marginally. The success rates for intubations may also be better.