Use of the bougie in simulated difficult intubation. 1. Comparison of the single‐use bougie with the fibrescope*

Abstract

SummaryWe studied the success rates for tracheal intubation in 64 healthy patients during simulated grade III laryngoscopy after induction of anaesthesia, using either the single-use bougie or oral flexible intubating fibrescope, both in conjunction with conventional Macintosh laryngoscopy. Patients were randomly allocated to either simulated grade IIIa or grade IIIb laryngoscopy, and also to one of the two study devices. Success rates for tracheal intubation (primary outcome measure) and times taken to achieve intubation (secondary outcome measure) were recorded. For the simulated grade IIIa laryngoscopy group, the fibreoptic scope was more successful than the bougie (16 ⁄ 16 successful intubations vs. 8 ⁄ 16; p ¼ 0.02). For the simulated grade IIIb laryngoscopy group, the fibreoptic scope was also more successful than the bougie (8 ⁄ 16 successful intubations vs. 1 ⁄ 16; p ¼ 0.02), but clearly use of the fibreoptic scope was not as successful as it had been in simulated grade IIIa laryngoscopy (p ¼ 0.04). With either device, median (range) total tracheal intubation times for successful attempts with either grade of laryngoscopy were less than 60 s (19-109) and there were no clinically important differences. We conclude that the fibrescope used in conjunction with Macintosh laryngoscopy is a more reliable method of tracheal intubation than the single-use bougie in both types of grade III laryngoscopy. This finding has implications for the management of patients in whom grade III laryngoscopy is encountered unexpectedly after induction of anaesthesia, and also for the management of patients previously known to have grade III view at laryngoscopy.

Comparison of the Levitan FPS Scope™ and the single‐use bougie for simulated difficult intubation in anaesthetised patients

“…We have chosen a simulation model as it is the next logical step from manikin studies to research into actual difficult intubations. Specifically, only grade IIIa laryngoscopy was performed due to the poor performance of the single-use bougie and to a lesser extent the fibrescope in grade IIIb laryngoscopy (when the epiglottis touches the posterior pharyngeal wall) [10]. The use of a Macintosh laryngoscope is consistent with clinical practice as both the bougie and the LFPS are commonly used in conjunction with direct laryngoscopy, although the latter can be used alone using jaw and tongue lift and a more extreme bend angle on the scope (70°).…”

“…Simulation of a grade IIIa view [9] was then achieved by lowering the laryngoscope blade such that the epiglottis was allowed to just obscure the view of the arytenoid cartilages. This method is an accepted technique for difficult airway simulation [10,11]. An operator held the laryngoscope in position to maintain the simulated grade IIIa view while the investigator confirmed the simulated view and proceeded with intubation.…”

Comparison of success of tracheal intubation using Macintosh laryngoscope-assisted Bonfils fiberscope and Truview video laryngoscope in simulated difficult airway

“…Hames et al . [21] have reported a median time of 37 s (19–46) when using gum elastic bougie, in similar simulated difficult airway scenario with only a 50% success against a 100% success in this study.…”

The Difficult Airway Society ‘ADEPT’ Guidance on selecting airway devices: the basis of a strategy for equipment evaluation

“…The replacement of re-usable products by single-use ones brought to light the reality that simply manufacturing a device to a broadly similar size or specifications did not guarantee similar outcomes (we are unaware of new single-use devices that actually performed better than their multi-use predecessors). Thus, a single-use bougie can be shown to perform extremely poorly in both clinical trials and manikin studies [6][7][8]. Single-use connectors for carbon dioxide monitoring marketed as 'low dead space devices' actually caused potentially dangerous airway obstruction, something that would have been apparent with a simple clinical trial [9].…”