Bougie - Revision history

Elcatracho: /* Benefits and Applications */

2025-02-16T15:20:24Z

Benefits and Applications

← Older revision		Revision as of 15:20, 16 February 2025
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	==Benefits and Applications==		==Benefits and Applications==
	*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>, however multicenter BOUGIE trial in ICU and ED setting failed to replicate these results.<ref>Driver BE, Semler MW, Self WH, Ginde AA, Trent SA, Gandotra S, Smith LM, Page DB, Vonderhaar DJ, West JR, Joffe AM, Mitchell SH, Doerschug KC, Hughes CG, High K, Landsperger JS, Jackson KE, Howell MP, Robison SW, Gaillard JP, Whitson MR, Barnes CM, Latimer AJ, Koppurapu VS, Alvis BD, Russell DW, Gibbs KW, Wang L, Lindsell CJ, Janz DR, Rice TW, Prekker ME, Casey JD; BOUGIE Investigators and the Pragmatic Critical Care Research Group. Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2021 Dec 28;326(24):2488-2497. doi: 10.1001/jama.2021.22002. PMID: 34879143; PMCID: PMC8655668.</ref>		*Single-center BEAM trial conducted in the ED 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>, however multicenter BOUGIE trial in ICU and ED setting failed to replicate these results.<ref>Driver BE, Semler MW, Self WH, Ginde AA, Trent SA, Gandotra S, Smith LM, Page DB, Vonderhaar DJ, West JR, Joffe AM, Mitchell SH, Doerschug KC, Hughes CG, High K, Landsperger JS, Jackson KE, Howell MP, Robison SW, Gaillard JP, Whitson MR, Barnes CM, Latimer AJ, Koppurapu VS, Alvis BD, Russell DW, Gibbs KW, Wang L, Lindsell CJ, Janz DR, Rice TW, Prekker ME, Casey JD; BOUGIE Investigators and the Pragmatic Critical Care Research Group. Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2021 Dec 28;326(24):2488-2497. doi: 10.1001/jama.2021.22002. PMID: 34879143; PMCID: PMC8655668.</ref>
	*Smaller diameter allows for increased visualization when passing through vocal cords		*Smaller diameter allows for increased visualization when passing through vocal cords
	*"Tracheal clicks" and "hold-up" signs for tactile confirmation of correct placement		*"Tracheal clicks" and "hold-up" signs for tactile confirmation of correct placement

Elcatracho: /* Benefits and Applications */

2025-02-16T15:19:43Z

Benefits and Applications

← Older revision		Revision as of 15:19, 16 February 2025
Line 8:		Line 8:

	==Benefits and Applications==		==Benefits and Applications==
	*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>		*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>, however multicenter BOUGIE trial in ICU and ED setting failed to replicate these results.<ref>Driver BE, Semler MW, Self WH, Ginde AA, Trent SA, Gandotra S, Smith LM, Page DB, Vonderhaar DJ, West JR, Joffe AM, Mitchell SH, Doerschug KC, Hughes CG, High K, Landsperger JS, Jackson KE, Howell MP, Robison SW, Gaillard JP, Whitson MR, Barnes CM, Latimer AJ, Koppurapu VS, Alvis BD, Russell DW, Gibbs KW, Wang L, Lindsell CJ, Janz DR, Rice TW, Prekker ME, Casey JD; BOUGIE Investigators and the Pragmatic Critical Care Research Group. Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2021 Dec 28;326(24):2488-2497. doi: 10.1001/jama.2021.22002. PMID: 34879143; PMCID: PMC8655668.</ref>
	*Smaller diameter allows for increased visualization when passing through vocal cords		*Smaller diameter allows for increased visualization when passing through vocal cords
	*"Tracheal clicks" and "hold-up" signs for tactile confirmation of correct placement		*"Tracheal clicks" and "hold-up" signs for tactile confirmation of correct placement

Elcatracho: /* Procedure */

2022-01-03T09:35:46Z

Procedure

← Older revision		Revision as of 09:35, 3 January 2022
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	==Procedure==		==Procedure==
	[[File:PMC4530924 wjem-16-588-g002.png\|thumb\|Emergency intubator demonstrating preloaded bougie technique on a mannequin.]]		[[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 [[Video Laryngoscopy\|video]] ~~with Macintosh blade~~)		* 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

Elcatracho: /* Complications */

2021-11-10T15:42:46Z

Complications

← Older revision		Revision as of 15:42, 10 November 2021
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	==Complications==		==Complications==
	* Theoretical risk of [[pneumothorax]] with hold-up sign		* Theoretical risk of [[pneumothorax]] with hold-up sign
	* Case reports of airway trauma secondary to bougie use
	* 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>		* 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==

Elcatracho: /* Pitfalls */

2021-07-08T19:51:43Z

Pitfalls

← Older revision		Revision as of 19:51, 8 July 2021
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	[[File:BEAM-Trouble-Shooting-1024x645.png\|thumb\|Source: rebelem.com]]		[[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~~, bevel is abutting the posterior cartilages~~, retract ~~the~~ tube 1-2 cm and rotate 90° CCW, then advance tube		* If resistance is met, retract tube 1-2 cm and rotate 90° CCW, then advance tube

	==See Also==		==See Also==

Elcatracho: /* Complications */

2021-07-08T19:51:08Z

Complications

← Older revision		Revision as of 19:51, 8 July 2021
Line 20:		Line 20:
	* Theoretical risk of [[pneumothorax]] with hold-up sign		* Theoretical risk of [[pneumothorax]] with hold-up sign
	* Case reports of airway trauma secondary to bougie use		* Case reports of airway trauma secondary to bougie use
	* ~~However, there is 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>		* 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>

	==Procedure==		==Procedure==

Elcatracho: /* See Also */

2021-06-22T18:16:58Z

Elcatracho: /* External Links */

2021-06-22T18:16:24Z

External Links

@@ Line 33: / Line 33: @@
 * Removing laryngoscope before railroading ETT can cause difficulty in passing the tube
 * If resistance is met, bevel is abutting the posterior cartilages, retract the tube 1-2 cm and rotate 90° CCW, then advance tube
 ==See Also==

Elcatracho: /* Overview */

2021-03-17T17:35:58Z

Overview

← Older revision		Revision as of 17:35, 17 March 2021
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	*First described by Macintosh in 1949<ref>Macintosh RR: An aid to oral intubation (letter). BMJ 1949; 1:28</ref>		*First described by Macintosh in 1949<ref>Macintosh RR: An aid to oral intubation (letter). BMJ 1949; 1:28</ref>
	*Modern form introduced in 1970's as Eschmann Endotracheal Introducer		*Modern form introduced in 1970's as Eschmann Endotracheal Introducer
	**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>		**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>
	*Made of polyester threads and outer resin layer		*Made of polyester threads and outer resin layer
	*Typically 60 cm, malleable, and with 60 degree angulated ''coudé'' tip		*Typically 60 cm, malleable, and with 60 degree angulated ''coudé'' tip

Elcatracho: /* External Links */

2021-03-14T00:38:30Z

External Links

← Older revision		Revision as of 00:38, 14 March 2021
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	==External Links==		==External Links==
	[https://www.acepnow.com/article/the-bougie-as-an-airway-savior/ ACEPNow: The Bougie as an Airway Savior]		*[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://vimeo.com/1085978 Video: The Bougie]

	[https://prehospitalmed.com/2016/04/14/bougie-intubation-with-the-kiwi-grip/ Kiwi Grip]		*[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://rebelem.com/bougie-use-in-emergency-airway-management-beam/ REBEL EM: BEAM Trial]

	[https://criticalcarenow.com/bougie-bonanza/ CriticalCareNow: Bougie Bonanza]		*[https://criticalcarenow.com/bougie-bonanza/ CriticalCareNow: Bougie Bonanza]

	==See Also==		==See Also==

@@ Line 64: / Line 64: @@
 **[[Mechanical ventilation (main)]]
 **[[Deterioration after intubation]] (DOPE)
 ==References==