The Bougie: An inexpensive lifesaving airway device

Background: "Bougies," otherwise known as endotracheal tube introducers, remain preferred devices for the emergency physician when faced with a difficult airway. Bougies have high success rates for the prehospital provider and the first-time emergency department (ED) user, with few reported complications. Inexpensive, disposable models provide simple yet valuable tools in the challenging patient with an anterior airway or limited neck mobility. Objectives: Use of the bougie is similar to standard endotracheal intubation. Correct placement is determined by feeling "clicks" as the device passes over the tracheal rings and a "hold up" when entering the distal airways. Case Reports: Three recent cases from our ED are briefly reported, in which the bougie was invaluable in the management of the difficult airway. All patients had limited visualization of the glottis but were intubated successfully. Conclusion: This article discusses three example cases, and then reviews the history of the bougie, placement technique, and current evidence for use.