A national survey of tracheal tube introducers and associated complications

Abstract

Tracheal tube introducers (bougies) are frequently used by anaesthetists in the UK for the management of difficult tracheal intubation. The re-usable gum elastic bougie (GEB) is regarded as the gold standard. However, there are concerns about the risks of cross-infection, detachment of the tip or fracture of the outer varnish layer with re-usable GEBs. Despite evidence showing that the GEB has a higher success rate for tracheal placement 1 and that single-use tracheal tube introducers have potential to produce airway trauma, oesophageal perforation and pneumothorax 2, 3, there has been a move towards single-use airway devices. Concerns have been raised about the lack of evidence for clinical efficacy or safety 4. With approval from the Difficult Airway Society (DAS) Survey Committee, an email with a link to an online survey was sent to all UK DAS members in March 2013, asking about the type of introducers used and whether any complications had been associated with their use. Results of the 485 DAS members who replied (36% response rate) are summarised in Table 1. Our data shows that the GEB is associated with the lowest complication rate and its use is preferred by the majority of DAS members. However, at approximately £30 (€38, $43), it is more than twice as expensive as single-use devices 5, and fewer hospitals are seemingly prepared to permit the routine use of the GEB compared to 10 years ago 6. We propose that newer single-use tracheal tube introducers require urgent further evaluation 7 before they are considered suitable replacements for the re-usable gum elastic bougie.