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HWN Suggests

The Bougie as an Airway Savior

The best way to master the bougie is practice. While the bougie has been around for almost three quarters of a century, it is still widely seen as a backup “adjunct.” However, recent evidence and forward-thinking emergency physicians are starting to change that paradigm. The widespread use of “bougie first” has the potential to revolutionize emergency airway management, leading to better outcomes for patients.

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Articles of Interest

Bougie

The name “gum elastic bougie” is erroneous – it is not made of resins, it is not elastic and it is not used for dilatation. aka Eschmann tracheal tube introducer.

Bougie use in tracheal intubation

This study reinforces my belief that we should plan on always using a bougie in EM/PHEM intubations.

InterGuide tracheal tube introducer bougie

InterGuide is a flexible tracheal tube introducer commonly known as a bougie. It allows positive location of the trachea and subsequent placement of the endotracheal tube in difficult airway situations. InterGuide is single use, latex free and supplied sterile in easy to open individual packs.

Should We Do Bougie First Intubation in Pediatrics?

The use of a bougie for pediatric intubation was not associated with increased first pass success or increased complication rates compared to an endotracheal tube (ETT) with a stylet at an academic emergency department where operators are facile with the bougie.

The Bougie and Airway Management: Revisiting an Old Friend

Perhaps our urological colleagues would argue that the bougie, useful for urethral dilatation purposes, rose to prominence within their specialty. Sir Robert R. Macintosh described the use of this catheter as an introducing adjunct for difficult intubations in 1949. Many years passed until Venn designed the currently used Eschmann introducer in the early 1970s, with alterations in its construction material to provide more stiffness while maintaining flexibility, lengthening it to 60 cm and adding the curved tip (35-degree coudé tip) to improve maneuverability. These changes contributed to the success of the ETI as an airway adjunct.

Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

A 5 Fr tracheal tube introducer (Portex, St. Paul, MN, USA) was used as GEB because there is no infant-size GEB with angle tip commercially available

Resources

Bougie Boussignac

Oro-tracheal flexible guide for difficult endotracheal intubation (Cormack superior to 2) with double lumen for oxygen injection and oxygen connector…

Size compatibility of airway equipment in children, ETT and LMA

Tubes, LMAs and bougies...