Bougie Molding During Laryngoscopy

There is lotsofevidence / that / using / a / bougie will increase your intubation success rate, compared to a styletted endotracheal tube. This is because the bougie is much smaller and easier to maneuver than an ETT, and does not block your view of the target at the last moment, as is often the case with a styletted tube. The Coudé tip allows operators to successfully intubate  grade 3, epiglottis-only views, which means if you are practiced with the bougie and can get a view of the epiglottis, you will be able to intubate.

A less discussed but powerful feature of the bougie is its capacity to be molded; this can be done prior to laryngoscopy (e.g. to conform to the shape of a curved laryngoscope) or during laryngoscopy to allow the bougie to act as a poor man’s flexible endoscope by allowing real-time adjustments to the tip’s trajectory.

This 4-minute video discusses the conventional floppy vs. newer malleable bougies and presents a case where molding a malleable bougie during laryngoscopy turned what could have been a very difficult airway with limited mouth opening into straightforward procedure, even for a junior operator.

There are many manufacturers of floppy and malleable bougies, I have no relationships with any of them.

Airborne Isolation / COVID19 Intubation Checklist

AIIC [pdf]

AIIC [image]

more pearls: make sure cuff is inflated prior to manual ventilation. attach viral filter directly to ETT, if circuit disconnection needed, disconnect circuit on vent side of filter.

References: Zuo 2020, Wax 2020, Weingart 2020, ecuus 1 and 2, Farkas & Thomas 2020

CDC 5 min video on proper donning/doffing, pdf, pulmcrit cheat sheet

 

CDC CV19 Discharge Instructions

LAC DOH CV19 Discharge Instructions

 

Scott’s BVM-on-NIV mask oxygenation setup (6 min vid)