By 1973, the introducer was described as a recognizable practical aid for difficult tracheal intubation. The clinical logic was already durable: secure a narrow route through the laryngeal inlet, then use that access to deliver the tube.

In 2000, Moscati and colleagues described the endotracheal tube introducer as a nonsurgical adjunct in three difficult emergency-department airways. The device remained closely associated with rescue, but its role was moving beyond the operating room.

BEAM was a single-center emergency-department trial with a strong local culture of bougie use. It found higher first-attempt success, with the clearest signal among patients with difficult-airway characteristics.

BOUGIE was a larger multicenter trial in critically ill adults. Routine bougie use did not improve first-attempt success over a styleted tube. Together, the studies argue against a universal verdict and toward attention to setting, airway characteristics, operator familiarity, and execution.

The 2024 systematic review found an association between bougie use and higher first-attempt success, but the certainty of evidence was low and the apparent benefit was greatest when the laryngeal view was difficult.

Pooling studies can clarify the direction of the signal. It cannot erase meaningful differences in patients, devices, airway setting, training, or the choreography used to deliver the tube.