The Case for Bougie Consideration in Every Intubation

Abstract

Dear Editors: We read with interest the article “The Case for Bougie Use on Every Intubation” recently published in Air Medical Journal by Merelman and would like to commend the author for his new perspective. As the great computer scientist Alan Kay said, “a change of perspective is worth 80 IQ points.” We find the Eschmann tracheal tube introducer or “bougie” to be a remarkably simple device with enormous value added and use it often in intubations. We certainly support the notion that it should be available in every intubation, and we include it as part of our routine equipment setup and checklist, but we would caution on its use in every intubation. Any medical device carries risks, and the decision to use a device is guided by good judgment weighing the clinician's assessment of risks and benefits. Good judgment comes from experience, and valuable experience is often derived from bad judgment; we encountered our fair share of bad judgment ourselves with the bougie. The author touched upon the complication of bronchopulmonary trauma but may be underestimating the risk of bronchospasm, which is among the scariest situations in the setting of a difficult airway.