this simulation study using manikins and pigs seemed to demonstrate the potential for tracheal trauma when using the holdup sign to confirm bougie is in trachea.
Whats the holdup sign you say?
Check out this paper then!
My service uses the single use Frova bougie described in this simulation study. I have not routinely used the holdup sign to confirm bougie is in trachea and now there is more theoretical reason for me not to!
I think better designed bougies will prevent injury, like the Introes Pocket bougie, made of Teflon and its tip is well rounded . Its also not as rigid as the Frova.