Bougie

A bougie or an endotracheal tube introducer is commonly utilized during difficult intubations, especially useful when the epiglottis but not the vocal cards are seen (Grade III Cormack-Lehane view). It is known by several names, bougie, gum elastic bougie, Eschmann, etc, and can be utilized in direct laryngoscopy, indirect, or even fiberoptic intubations. Generally, 60cm in length with a flexible tip bent at a 30 degree angle to facilitate passage under the epiglottis.

For example, during direct laryngoscopy, once the epiglottis is visualized, the provider would pass the bougie with their right hand under the epiglottis and through the vocal cords blindly. It is then further advanced where the angled tip can create a palpable bumping or clicking against the anterior tracheal rings, confirming placement. The laryngoscope is then removed and an endotracheal tube ia passed over the bougie. Due to the flexible nature of a bougie is is less likely than more rigid devices to cause laryngeal or tracheal injury. One downside of a bougie is the inability to ventilate through it, as it is a solid introducer device (vs Aintree intubation catheter)