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Chapter 15 - Tracheal Tube Introducers (Bougies), Stylets and Airway Exchange Catheters

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

By
Massimiliano Sorbello  and
Iljaz Hodzovic
Edited by
Tim Cook  and
Michael Seltz Kristensen
Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

Tracheal tube introducers or bougies and airway exchange catheters (AECs) are widely used airway adjuncts for facilitating airway management in difficult circumstances. They are easy to use, relatively inexpensive and have success rates of ≥ 90% in most settings. Both are included in many modern airway management algorithms. The use of bougies has expanded over the years, and they are now used to aid insertion of supraglottic airways (SGAs), videolaryngoscope-guided intubation and as adjuncts to emergency front of neck airway procedures. Stylets are rigid or semi-rigid airway adjuncts that are inserted into the tracheal tube before intubation. They maintain the tracheal tube in a particular shape and may therefore assist during intubation. AECs are semi-rigid hollow tubes designed to aid airway device (SGA, and single- or double-lumen tracheal tube) exchange or to manage ‘at-risk’ extubation. The risk of serious airway trauma associated with the use of bougies and airway exchange catheters, and the risk of barotrauma with the latter, invites cautious and educated use of these devices.

Keywords

Airwayairway exchange catheterbougiedifficultintroducerintubationstyletvideolaryngoscopy
Type
Chapter
Information
Core Topics in Airway Management , pp. 130 - 139
Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Axe, R, Middleditch, A, Kelly, FE, Batchelor, TJ, Cook, TM. (2015). Macroscopic barotrauma caused by stiff and soft-tipped airway exchange catheters: an in vitro case series. Anesthesia & Analgesia, 120, 355–361.Google Scholar
Driver, BE, Prekker, ME, Klein, LR, et al. (2018). 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, 319, 2179–2189.CrossRefGoogle ScholarPubMed
Duggan, LV, Law, JA, Murphy, MF. (2011). Brief review: supplementing oxygen through an airway exchange catheter: efficacy, complications, and recommendations. Canadian Journal of Anaesthesia, 58, 560–568.CrossRefGoogle ScholarPubMed
Hodzovic, I, Latto, IP, Wilkes, AR, Hall, JE, Mapleson, WW. (2004). Evaluation of Frova, single-use intubation introducer, in a manikin. Comparison with Eschmann multiple-use introducer and Portex single-use introducer. Anaesthesia, 59, 811–816.Google Scholar
Nolan, JP, Wilson, ME. (1992). An evaluation of the gum elastic bougie. Intubation times and incidence of sore throat. Anaesthesia, 47, 878–881.CrossRefGoogle ScholarPubMed

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