Why It’s Good to Be Bougie

A NEXTGEN LEARNING SPACE DEsigned to ELEVATE YOUR AIRWAY PRACTICE

start here

In this space, let’s discuss why it’s okay to be bougie. You may wonder why this “accessory” to intubation is still around, but the evidence suggests expanded possibilities for their use beyond as a rescue device for difficult airways, and there are some good reasons for this.

Navigation

This space is organized from rapid review to deep dive to bring you the most essential knowledge first. You can also customize your learning by exploring what’s important to you by using the navigation tool below.

Audio Intro	Rapid Review	Expanded Use
Full Video	Evidence Review	FOAMed
Source Material	Next Steps	To Evolution TI

Rapid Review

Get some high speed hits of essential knowledge and prime yourself for what comes next. ⏩

what’s the difference?

What is the reason tube introducers continue to evolve and expand their role in airway management? It’s because they’re designed with a single purpose: tracheal access, and subsequently, enhanced tube delivery. Let’s quickly compare some of the common design features of tube introducers vs the design features of the modern endotracheal tubes, and then you’ll begin to see their advantage when it comes to intubation success.

Expanding Indications

When most people think of tube introducers they think of the standard blue bougie, and then only as a difficult airway adjunct, but evidence suggests it has an expanding number of roles in clinical practice. Here are just a few.

design with purpose

Many people ask us, do you even need to learn about tube introducers in the age of VL? I thought they were a relic of the DL age? Well, not so fast. Let’s talk about the design features and intention of the bougie to help explain why they remain a valuable part of your airway practice.

Some Evidence

There’s some good evidence that tube introducers like the standard bougie can improve first pass success. Some clinicians, particularly those in emergency settings have seen this potentially game changing evidence, and shifted to a “bougie first” mindset.

Evidence Based Bougie – How do tube introducers stack up when compared to stylets?

For me, the evolution of bougie use is similar to our evolution of the use of NIPPV in APE: ie we often used it too late and as last a resort. Now we know better. Today, I'm much more likely to make the bougie part of my "plan A" Give me your thoughts… pic.twitter.com/ePKtyBvK12
— mRNAtion (@jstgeorgemd) August 16, 2019

clinical pearl

Something to consider as you work on your bougie skills. It can be more than just a backup plan📚

Tracheal tubes are designed for mechanical ventilation, not intubation. Using a stylet or bougie will facilitate your ability to deliver the tube into the trachea and thus improve FPS. This has demonstrated in the STYLETO trial and the BEAM trial.
— AirwayMan (@JohnCSakles) May 30, 2021

foam resource

@JohnCSakles is one of our favorite FOAMed airway educators. He is in our extended learning network. Take a moment and put him in yours. You’ll be glad you did 📚

Return to the Source

Dive into some the most intriguing and practice changing papers published on this topic. We’ve gone to the source and collected what we think are the ones you should definitely know about.

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. Brian E Driver¹, Matthew E Prekker^1 2, Lauren R Klein¹, Robert F Reardon¹, James R Miner¹, Erik T Fagerstrom¹, Mitchell R Cleghorn³, John W McGill¹, Jon B Cole¹ JAMA; 018 Jun 5;319(21):2179-2189. doi: 10.1001/jama.2018.6496.
Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting Andrew J. Latimer, MD Brenna Harrington, Catherine R. Counts, PhD, MHA Charles Maynard, PhD Taketo Watase, MD Michael R. Sayre, MD Published:December 17, 2020DOI: https://doi.org/10.1016/j.annemergmed.2020.10.016

WHAT’S NEXT

Sure you could stop here, but why would you? If you’re in the physical learning space: 1. Locate any of the posters below to continue. 2. Look for integrated hands-on training opportunities using guided audio and videos to enhance your practice. 🎧👇3. Visit faculty coaches to get feedback on your technique. If you’re online, head back to the complete digital learning space using the link below.