Bougie: Difference between revisions
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==Overview== | ==Overview== | ||
* First described by Macintosh in 1949 ( | [[File:PMC4530924 wjem-16-588-g001.png|thumb|"Preloaded" bougie setup.]] | ||
* Modern form introduced in 1970's as Eschmann Endotracheal | *First described by Macintosh in 1949<ref>Macintosh RR: An aid to oral intubation (letter). BMJ 1949; 1:28</ref> | ||
Introducer | *Modern form introduced in 1970's as Eschmann Endotracheal Introducer | ||
* Made of polyester threads and outer resin layer | **It is neither ''gum'', nor ''elastic'' nor a ''bougie''<ref>Mohammad I. El-Orbany, M Ramez Salem, Ninos J. Joseph; The Eschmann Tracheal Tube Introducer Is Not Gum, Elastic, or a Bougie. Anesthesiology 2004; 101:1240</ref> | ||
* Typically 60 cm, malleable, and with 60 degree angulated '' | *Made of polyester threads and outer resin layer | ||
*Typically 60 cm, malleable, and with 60 degree angulated ''coudé'' tip | |||
==Benefits and Applications== | ==Benefits and Applications== | ||
* BEAM trial showed 98% | *BEAM trial showed 98% first-pass success using a bougie compared to 87% using stylet for [[Intubation|intubation]].<ref>Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, Cleghorn MR, McGill JW, Cole JB. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018 Jun 5;319(21):2179-2189. doi: 10.1001/jama.2018.6496. PMID: 29800096; PMCID: PMC6134434.</ref> | ||
* | *Smaller diameter allows for increased visualization when passing through vocal cords | ||
* | *"Tracheal clicks" and "hold-up" signs for tactile confirmation of correct placement | ||
* Especially helpful with Cormack-Lehane views II-IV (can be passed blind and placement confirmed with tactile feedback) | *Especially helpful with Cormack-Lehane views II-IV (can be passed blind and placement confirmed with tactile feedback) | ||
* Used in "scalpel-bougie-tube" cricothyrotomy technique | *Used in "scalpel-bougie-tube" [[Surgical cricothyrotomy|cricothyrotomy]] technique | ||
* Can assist [[Blind Digital Intubation|blind digital intubation]] | *Can assist [[Blind Digital Intubation|blind digital intubation]] | ||
* Can rotate 90° CW or CWW to selectively intubate non-bleeding lung in cases of massive hemoptysis | *Can rotate 90° CW or CWW to selectively intubate non-bleeding lung in cases of massive [[hemoptysis]]<ref>Gottlieb M, Sharma V, Field J, Rozum M, Bailitz J. Utilization of a gum elastic bougie to facilitate single lung intubation. Am J Emerg Med. 2016 Dec;34(12):2408-2410. doi: 10.1016/j.ajem.2016.08.057. Epub 2016 Aug 27. PMID: 27614374.</ref> | ||
* Compatible with Macintosh blade and standard geometry video larygoscopes | *Compatible with Macintosh blade and standard geometry [[Video laryngoscopy|video larygoscopes]] | ||
==Complications== | ==Complications== | ||
* Theoretical risk of pneumothorax with hold-up sign | * Theoretical risk of [[pneumothorax]] with hold-up sign | ||
* | * No high-quality evidence to suggest bougie use leads to increased mechanical complications of intubation<ref>Hodzovic I, Latto IP, Henderson JJ. Bougie trauma--what trauma? Anaesthesia. 2003 Feb;58(2):192-3. doi: 10.1046/j.1365-2044.2003.03005_16.x. PMID: 12562428.</ref> | ||
** BEAM trial showed no difference in incidence of airway trauma between bougie and stylet groups | |||
==Procedure== | ==Procedure== | ||
* Obtain view with Mac blade laryngoscope ([[Direct laryngoscopy|direct]] or [[Video Laryngoscopy|video]]) | [[File:PMC4530924 wjem-16-588-g002.png|thumb|Emergency intubator demonstrating preloaded bougie technique on a mannequin.]] | ||
* Obtain view with Mac blade laryngoscope ([[Direct laryngoscopy|direct]] or "standard-geometry" [[Video Laryngoscopy|video]]) | |||
* Pass bougie - confirm with tracheal clicks and/or hold up sign | * Pass bougie - confirm with tracheal clicks and/or hold up sign | ||
* Have assistant "railroad" tube over bougie | * Have assistant "railroad" tube over bougie | ||
* Alternatively can use | * Alternatively can use preloaded ETT over bougie for single-operator using "kiwi" grip | ||
==Pitfalls== | ==Pitfalls== | ||
[[File:BEAM-Trouble-Shooting-1024x645.png|thumb|Source: rebelem.com]] | |||
* Removing laryngoscope before railroading ETT can cause difficulty in passing the tube | * Removing laryngoscope before railroading ETT can cause difficulty in passing the tube | ||
* If resistance is met | * If resistance is met, retract tube 1-2 cm and rotate 90° CCW, then advance tube | ||
==See Also== | ==See Also== | ||
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**[[Deterioration after intubation]] (DOPE) | **[[Deterioration after intubation]] (DOPE) | ||
== | ==External Links== | ||
*[https://www.acepnow.com/article/the-bougie-as-an-airway-savior/ ACEPNow: The Bougie as an Airway Savior] | |||
*[https://vimeo.com/1085978 Video: The Bougie] | |||
*[https://prehospitalmed.com/2016/04/14/bougie-intubation-with-the-kiwi-grip/ Kiwi Grip] | |||
*[https://rebelem.com/bougie-use-in-emergency-airway-management-beam/ REBEL EM: BEAM Trial] | |||
*[https://criticalcarenow.com/bougie-bonanza/ CriticalCareNow: Bougie Bonanza] | |||
==References== | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Critical Care]] |
Latest revision as of 09:35, 3 January 2022
Overview
- First described by Macintosh in 1949[1]
- Modern form introduced in 1970's as Eschmann Endotracheal Introducer
- It is neither gum, nor elastic nor a bougie[2]
- Made of polyester threads and outer resin layer
- Typically 60 cm, malleable, and with 60 degree angulated coudé tip
Benefits and Applications
- BEAM trial showed 98% first-pass success using a bougie compared to 87% using stylet for intubation.[3]
- Smaller diameter allows for increased visualization when passing through vocal cords
- "Tracheal clicks" and "hold-up" signs for tactile confirmation of correct placement
- Especially helpful with Cormack-Lehane views II-IV (can be passed blind and placement confirmed with tactile feedback)
- Used in "scalpel-bougie-tube" cricothyrotomy technique
- Can assist blind digital intubation
- Can rotate 90° CW or CWW to selectively intubate non-bleeding lung in cases of massive hemoptysis[4]
- Compatible with Macintosh blade and standard geometry video larygoscopes
Complications
- Theoretical risk of pneumothorax with hold-up sign
- No high-quality evidence to suggest bougie use leads to increased mechanical complications of intubation[5]
- BEAM trial showed no difference in incidence of airway trauma between bougie and stylet groups
Procedure
- Obtain view with Mac blade laryngoscope (direct or "standard-geometry" video)
- Pass bougie - confirm with tracheal clicks and/or hold up sign
- Have assistant "railroad" tube over bougie
- Alternatively can use preloaded ETT over bougie for single-operator using "kiwi" grip
Pitfalls
- Removing laryngoscope before railroading ETT can cause difficulty in passing the tube
- If resistance is met, retract tube 1-2 cm and rotate 90° CCW, then advance tube
See Also
Airway Pages
- Pre-intubation
- Induction
- Intubation
- Surgical airways
- Post-intubation
External Links
References
- ↑ Macintosh RR: An aid to oral intubation (letter). BMJ 1949; 1:28
- ↑ Mohammad I. El-Orbany, M Ramez Salem, Ninos J. Joseph; The Eschmann Tracheal Tube Introducer Is Not Gum, Elastic, or a Bougie. Anesthesiology 2004; 101:1240
- ↑ Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, Cleghorn MR, McGill JW, Cole JB. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018 Jun 5;319(21):2179-2189. doi: 10.1001/jama.2018.6496. PMID: 29800096; PMCID: PMC6134434.
- ↑ Gottlieb M, Sharma V, Field J, Rozum M, Bailitz J. Utilization of a gum elastic bougie to facilitate single lung intubation. Am J Emerg Med. 2016 Dec;34(12):2408-2410. doi: 10.1016/j.ajem.2016.08.057. Epub 2016 Aug 27. PMID: 27614374.
- ↑ Hodzovic I, Latto IP, Henderson JJ. Bougie trauma--what trauma? Anaesthesia. 2003 Feb;58(2):192-3. doi: 10.1046/j.1365-2044.2003.03005_16.x. PMID: 12562428.