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Barnicle RN, Bracey A, Weingart SD. Managing Emergency Endotracheal Intubation Utilizing a Bougie. Ann Emerg Med 2024:S0196-0644(24)00232-4. [PMID: 38912998 DOI: 10.1016/j.annemergmed.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 06/25/2024]
Affiliation(s)
- Ryan N Barnicle
- Department of Emergency Medicine, the Warren Alpert Medical School of Brown University, Providence, RI.
| | - Alexander Bracey
- Department of Emergency Medicine, Albany Medical Center, Albany, NY
| | - Scott D Weingart
- Department of Emergency Medicine, Nausea County Medical Center, East Meadow, NY
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Vasconcelos Pereira A, Simões AV, Rego L, Pereira JG. New technologies in airway management: A review. Medicine (Baltimore) 2022; 101:e32084. [PMID: 36482552 PMCID: PMC9726337 DOI: 10.1097/md.0000000000032084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The evolution of medical knowledge and technological growth have contributed to the development of different techniques and devices for airway management. These appear to play a role in optimizing the number of attempts and overall success, ultimately reducing the negative consequences of airway manipulation. In this literature review, we highlight the recent evidence regarding new technologies applied to airway management. Before intubation, every patient should have an individualized structured airway management plan. Technology can help with both airway evaluation and tracheal intubation. Point-of-care cervical ultrasound and artificial intelligence models with automated facial analysis have been used to predict difficult airways. Various devices can be used in airway management. This includes a robotic video endoscope that guides intubation based on real image recognition, a laryngeal mask with a non-inflatable cuff that tries to reduce local complications, video laryngeal masks that are able to confirm the correct position and facilitate intubation, Viescope™, a videolaryngoscope developed for combat medicine with a unique circular blade, a system that uses cervical transillumination for glottis identification in difficult airways and Vivasight SL™ tracheal tube, which has a high-resolution camera at its tip guaranteeing visual assurance of tube position as well as guiding bronchial blocker position. To conclude, we detailed the challenges in airway management outside the operating room as well as described suction-assisted laryngoscopy and airway decontamination technique for contaminated airways. Further research in the clinical setting is recommended to better support the use of these technologies.
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Affiliation(s)
- Ana Vasconcelos Pereira
- Anesthesiology Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
- * Correspondence: Ana Vasconcelos Pereira, Department of Anesthesiology, Hospital Vila Franca de Xira, Estrada Carlos Lima Costa Nº 2, Povos 2600-009 - Vila Franca DE Xira, Portugal (e-mail: )
| | - André Vicente Simões
- Intensive Care Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
| | - Luísa Rego
- Anesthesiology Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
| | - João Gonçalves Pereira
- Intensive Care Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
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Mahli N, Md Zain J, Mahdi SNM, Chih Nie Y, Chian Yong L, Shokri AFA, Maaya M. The Performance of Flexible Tip Bougie™ in Intubating Simulated Difficult Airway Model. Front Med (Lausanne) 2021; 8:677626. [PMID: 34026801 PMCID: PMC8137891 DOI: 10.3389/fmed.2021.677626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
This prospective, randomized, cross-over study compared the performance of the novel Flexible Tip Bougie™ (FTB) with a conventional bougie as an intubation aid in a simulated difficult airway manikin model among anaesthesiology trainees with regards of first pass success rate, time to intubation, number of attempts and ease of use. Sixty-two anesthesiology trainees, novice to the usage of FTB, participated in this study. Following a video demonstration, each participant performed endotracheal intubation on a manikin standardized to a difficult airway view. Each participant performed direct laryngoscopy and intubated the manikin using a conventional bougie and FTB, at least 1 day in between devices, in a randomized order. The first pass success rate was significantly higher with FTB (98.4%) compared to conventional bougie (85.5%), p = 0.008. The median time to intubation was significantly faster when using FTB, median = 32.0 s [Interquartile range (IQR): 23.8–41.3 s] compared to when using conventional bougie, median = 41.5 s (IQR: 31.8–69.5 s), p < 0.001. The FTB required significantly less intubation attempts compared to conventional bougie, p = 0.024. The overall ease of use, scored on a Likert scale from 1 to 5, was significantly higher in the FTB (4.26 ± 0.53) compared to the conventional bougie (3.19 ± 0.83), p < 0.001. This simulated difficult airway manikin study finding suggested that FTB is a useful adjunct for difficult airway intubation. The FTB offered a higher first pass success rate with a faster time to intubation and less required attempts.
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Affiliation(s)
- Nurfadilah Mahli
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Jaafar Md Zain
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Siti Nidzwani Mohamad Mahdi
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yeoh Chih Nie
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Liu Chian Yong
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Fairuz Abdul Shokri
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Maaya
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Ruetzler K, Smereka J, Abelairas-Gomez C, Frass M, Dabrowski M, Bialka S, Misiolek H, Plusa T, Robak O, Aniolek O, Ladny JR, Gorczyca D, Ahuja S, Szarpak L. Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial. BMC Anesthesiol 2020; 20:90. [PMID: 32312225 PMCID: PMC7171857 DOI: 10.1186/s12871-020-01009-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization. Conclusion In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. Trial registration clinicaltrials.gov Identifier: NCT03733158. 7th November 2018.
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Affiliation(s)
- Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesia, Cleveland Clinic, Anesthesiology Institute, Cleveland, OH, USA
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Cristian Abelairas-Gomez
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.,Faculty of Education, University Santiago de Compostela, Santiago de Compostela, Spain.,Institute of Research of Santiago (IDIS) and SAMID-II Network, Santiago de Compostela, Spain
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marek Dabrowski
- Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
| | - Szymon Bialka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Hanna Misiolek
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Tadeusz Plusa
- Medical Faculty, Lazarski University, Warsaw, Poland
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Olga Aniolek
- Polish Society of Disaster Medicine, Swieradowska 43 Str, 02-662, Warsaw, Poland
| | - Jerzy Robert Ladny
- Department of Emergency Medicine, Medical University Bialystok, Bialystok, Poland
| | - Damian Gorczyca
- Polish Society of Disaster Medicine, Swieradowska 43 Str, 02-662, Warsaw, Poland
| | - Sanchit Ahuja
- Department of Anesthesia, Henry Ford Health System, Detroit, MI, USA
| | - Lukasz Szarpak
- Polish Society of Disaster Medicine, Swieradowska 43 Str, 02-662, Warsaw, Poland.
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Driver B, Dodd K, Klein LR, Buckley R, Robinson A, McGill JW, Reardon RF, Prekker ME. The Bougie and First-Pass Success in the Emergency Department. Ann Emerg Med 2017; 70:473-478.e1. [PMID: 28601269 DOI: 10.1016/j.annemergmed.2017.04.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/14/2017] [Accepted: 04/19/2017] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE The bougie may improve first-pass intubation success in operating room patients. We seek to determine whether bougie use is associated with emergency department (ED) first-pass intubation success. METHODS We studied consecutive adult ED intubations at an urban, academic medical center during 2013. Intubation events were identified by motion-activated video recording. We determined the association between bougie use and first-pass intubation success, adjusting for neuromuscular blockade, video laryngoscopy, abnormal airway anatomy, and whether the patient was placed in the sniffing position or the head was lifted off the bed during intubation. RESULTS Intubation with a Macintosh blade was attempted in 543 cases; a bougie was used on the majority of initial attempts (80%; n=435). First-pass success was greater with than without bougie use (95% versus 86%; absolute difference 9% [95% confidence interval {CI} 2% to 16%]). The median first-attempt duration was higher with than without bougie (40 versus 27 seconds; difference 14 seconds [95% CI 11 to 16 seconds]). Bougie use was independently associated with greater first-pass success (adjusted odds ratio 2.83 [95% CI 1.35 to 5.92]). CONCLUSION Bougie was associated with increased first-pass intubation success. Bougie use may be helpful in ED intubation.
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Affiliation(s)
- Brian Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
| | - Kenneth Dodd
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Lauren R Klein
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Ryan Buckley
- University of Minnesota School of Medicine, Minneapolis, MN
| | - Aaron Robinson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - John W McGill
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Robert F Reardon
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Division of Pulmonary/Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
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Kingma K, Hofmeyr R, Zeng IS, Coomarasamy C, Brainard A. Comparison of four methods of endotracheal tube passage in simulated airways: There is room for improved techniques. Emerg Med Australas 2017; 29:650-657. [DOI: 10.1111/1742-6723.12874] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/26/2017] [Accepted: 05/10/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Kirsten Kingma
- Department of Medicine; Stellenbosch University; Stellenbosch South Africa
| | - Ross Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences; University of Cape Town; Cape Town South Africa
| | - Irene Suilan Zeng
- Research and Evaluation Office; Ko Awatea, Middlemore Hospital; Auckland New Zealand
- Department of Statistics; The University of Auckland; Auckland New Zealand
| | - Christin Coomarasamy
- Research and Evaluation Office; Ko Awatea, Middlemore Hospital; Auckland New Zealand
| | - Andrew Brainard
- Emergency Medicine; Middlemore Hospital; Auckland New Zealand
- Emergency Medicine; The University of Auckland; Auckland New Zealand
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Dexheimer Neto FL, de Andrade JMS, Raupp ACT, da Silva Townsend R, Neres FS, Cremonese RV. Use of a homemade introducer guide (bougie) for intubation in emergency situation in patients who present with difficult airway: a case series. Braz J Anesthesiol 2016; 66:204-7. [PMID: 26952232 DOI: 10.1016/j.bjane.2013.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of difficult airway reaches 10% of emergency intubations. Although few studies address the use of handmade introducer guides in emergency and intensive care environment, there are descriptions of handmade guides available on the Internet. We describe a case series on the use of a handmade introducer guide (bougie) for emergency intubation in patients with difficult airway. CASE REPORT The handmade introducer guide was used in five consecutive patients with difficult airways, and clinical instability and in the absence of another immediate method to obtain an airway. This technique provided successful intubation and there were no complications. CONCLUSIONS The use of the handmade introducer guide can be a useful option for the management of difficult airways.
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Affiliation(s)
| | | | | | | | - Fernanda Santos Neres
- Unidade de Terapia Intensiva Adulto, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
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Pirotte M, Pirotte A, Trueger NS. Digitally assisted bougie intubation: a novel technique for difficult airway management. Am J Emerg Med 2015; 33:1845.e3-4. [DOI: 10.1016/j.ajem.2015.04.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022] Open
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Dexheimer Neto FL, Andrade JMSD, Raupp ACT, Townsend RDS, Neres FS, Cremonese RV. [Use of a homemade introducer guide (bougie) for intubation in emergency situation in patients who present with difficult airway: a case series]. Rev Bras Anestesiol 2014; 66:204-7. [PMID: 26546210 DOI: 10.1016/j.bjan.2013.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/10/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of difficult airway reaches 10% of emergency intubations. Although few studies address the use of handmade introducer guides in emergency and intensive care environment, there are descriptions of handmade guides available on the Internet. We describe a case series on the use of a handmade introducer guide (bougie) for emergency intubation in patients with difficult airway. CASE REPORT The handmade introducer guide was used in five consecutive patients with difficult airways, and clinical instability and in the absence of another immediate method to obtain an airway. This technique provided successful intubation and there were no complications. CONCLUSIONS The use of the handmade introducer guide can be a useful option for the management of difficult airways.
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Affiliation(s)
| | | | | | | | - Fernanda Santos Neres
- Unidade de Terapia Intensiva Adulto, Hospital Ernesto Dornelles, Porto Alegre, RS, Brasil
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