Bougies three ways
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
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.
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
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
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
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.