Trial reportIntensive care medicine2021
Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients.
Trial report in Intensive care medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 43 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Endotracheal Tube Plus STYLET Versus Endotracheal Tube Alone on Successful First-Pass Orotracheal Intubation Among Critically Ill Patients: the Randomised STYLETO Study Protocol"
A Randomized Comparison Between the Flexible Tip Bougie Vs Tube with Stylet for First-attempt Intubation Success with a Videolaryngoscopy in ICU Patients
Impact of End-tidal Oxygen Monitoring During Preoxygenation Before Intubation for Acute Hypoxemic Respiratory Failure in ICU Setting: The PFOX Pilot Study.
Who cites it
43 citing papers in PubMed, 90 citations in OpenAlex.
- Conventional vs Video-Assisted Laryngoscopy for Perioperative Endotracheal Intubations: A Randomized Clinical Trial.JAMA network open · 2026Trial
- Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial.BMC anesthesiology · 2024Trial
- Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults.The New England journal of medicine · 2023Trial
- Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.Intensive care medicine · 2022Trial
- Airway management in critically ill patients with obesity.Intensive care medicine · 2026Review
- Best practices in airway management in critically ill adults.Intensive care medicine · 2025Article
- All India Difficult Airway Association 2025 Guidelines for the management of unanticipated difficult airway in adults under general anaesthesia.Indian journal of anaesthesia · 2025Article
- Article
- Impact of Checklist Implementation on Endotracheal Intubation-Related Complications in Critically Ill Adults-A Retrospective Before and After Study.Acta anaesthesiologica Scandinavica · 2025Observational
- Evidence-based Emergency Tracheal Intubation.American journal of respiratory and critical care medicine · 2025Review
- Successful Conservative Treatment of Tracheobronchial Injury as a Complication After Emergency Tracheal Intubation in an Infant: A Case Report.The American journal of case reports · 2025Article
- Assessment of adverse events associated with medical devices among respiratory disorder patients at a tertiary care hospital.The Indian journal of medical research · 2025Article
- Hyperangulated videolaryngoscopy.BJA education · 2025Review
- Peri-intubation adverse events and clinical outcomes in emergency department patients: the BARCO study.Critical care (London, England) · 2025Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.Journal of intensive care · 2025Article
- Intubation bundle: A prospective observational tertiary cancer centre study of clinical practice and adverse events of tracheal intubation out of operation theatre.Northern clinics of Istanbul · 2025Article
- Resuscitation and Initial Management After Moderate-to-Severe Traumatic Brain Injury: Questions for the On-Call Shift.Journal of clinical medicine · 2024Review
- Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study.Intensive care medicine · 2024Article
- Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrathTM video laryngoscope: a prospective randomized trial.Anesthesia and pain medicine · 2024Article
- Comment on "Usefulness of C-curved stylet for intubation with the C-MAC® Miller videolaryngoscope in neonates and infants: a prospective randomized controlled trial".Korean journal of anesthesiology · 2024Article
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Authors and funding
31 authors at 20 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.
methodsIn this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.
resultsA total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4-12.1; relative risk, 1.10; 95%CI 1.02-1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, - 1.5; 95%CI - 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83-1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, - 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59-2.06. P = 0.76).
conclusionsAmong critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.