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Bougies three ways

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hi folks

My mate Jim DuCanto sent me a gift of a Bomimed Pocket Bougie so I thought I would do a quick review of 3 bougies to compare.

Firstly I have no financial disclosures to any of the three bougies nor their manufacturers

Secondly, my service, RFDS Queensland section utilises the Cook Frova bougie(tracheal tube introducer) and the one I demonstrate here is from a box I bought personally. The SunMed bougie is from a box I bought personally as well, from Dr Levitan’s website, Airwaycam

Thirdly cost wise : SunMed bougie ( box of 10) = $65 approx, Pocket Bougie =$25ea or $16 ea for bulk purchase (not available for pruchase in Australia yet), Cook Frova Bougie =(box of 10) $200 approx

Here are the bougies as they come newly packaged

Pocket bougie

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There is no doubt the Pocket Bougie fits into your pocket and so is easily carried with you on a shift. It does mean though it is shorter than the other two . To test them all in terms of being able to fit into a pocket I tied them all into a knot each.

Bougies in knots

The most portable due to its shorter length is the Pocket Bougie. Here is what happened when I unwrapped the knots and let them rest

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You can see the Pocket Bougie retains a curved shape the most and this is by intentional design. It is impossible to mold the Pocket Bougie into a straight linear shape. The Cook and Sunmed Bougies are malleable and after straightening all three as best as I could here is what they looked like

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For direct laryngoscopy intubation, all three bougies perform fine. Its just you need to learn a slightly different technique and way to hold the Pocket Bougie. Its not flimsy and has some weight to its shaft which makes up for its shorter length. I tested all three on an Ambu intubating mannikin using direct laryngoscopy and VL with a King Vision VL device.

The Pocket Bougie works best with indirect larygnoscopes like Glidescope and King Vision as it has such a curve to its body.

here is Jim demonstrating it with a Glidescope

 

The Cook Frova bougie is the most expensive as it has a ventilation lumen and port, demonstrated in this video

My verdict:

All three bougies are fine tube introducers with the SunMed being the cheapest but the Pocket Bougie being the most portable.

 

In conclusion: Bougies, tracheal tube introducers, whatever you want to call them, are a resilient airway device to have in your toolbox. They improve your success with direct and video laryngoscopy, and now also with surgical airway techniques. Remember there are even reports of it being used to aid chest drain insertion! One other cool use I read on Dr Reuben Strayer’s blogsite, EMUpdates, was from their EDICT airway protocol (developed with Scott Weingart). A bougie can be used to confirm tracheal placement of ETT by passing it down and feeling for hangup at 30-40cm approx depth in adult.

5 Comments Post a comment
  1. Useful post Minh – glad to say that 97% of rural docs in Oz have access to a bougie (bit worried about the other 3%, but never mind).

    No financial interest in any of these devices – locally I use the Frova (without introducer) but remain intrigued with the pocket bougie – good reviews from Stateside and more importantly it’s small size makes inclusion on a difficult airway trolley or box a certainty.

    In these exciting times of VL vs DL, iLMA conduit for blind or FO ETT and other gizmos, we should remember that a bougie is ‘good enough’ for the majority of situations

    Except of course for the tragic case of Michael Jackson. Leaving aside the foolhardiness of a cardiologist administering propofol for insomnia, once his airway reflexes were obtunded and the paramedics arrived, it should have been easy to place a definitive airway.

    The way I heard it, poor old Michael Jackson was a difficult intubation…the paramedics ‘blamed it on the bougie’

    I’ll get my coat now…

    December 1, 2012
  2. It was a real dad joke.

    Sorry.

    Will try harder….

    December 1, 2012
  3. Sam Wong #

    Hi Minh, I can confirm for you that I have seen the pocket bougie in Australia at the Melbourne ANZCA ASM. It is being distributed by the “Critical Group” (who had up until now supplied the King Vision).

    I’m going to see if I can get a trial for the RFDS WA.

    May 8, 2013

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