A novel bougie for exchange of double lumen tube.

Abstract

Sir, Exchanging double-lumen endotracheal tube (DLT) with single lumen conventional endotracheal tube (ET) at the conclusion of thoracic[1] and cardiac surgeries is a common procedure, which is usually performed anticipating the need of postoperative mechanical ventilation. This step assumes critical magnitude especially in those patients whose initial airway control becomes difficult. Moreover, depending on the type of surgery, its duration and fluids infused during surgery, an airway which was initially normal has the propensity to become difficult by the end of surgery. Mucosal oedema, bleeding and retained secretions which are common after surgical procedures can further complicate the airway anatomy. Various techniques are been described for replacing DLT by ET.[2,3] Among the popular methods are using bougies, airway guides or airway exchange catheters, whereby the DLT is removed over an airway guide, and the guide remains in the trachea which allows immediate access to the airway whenever reintubation is needed.[4] Currently, several types of bougies are available for initial airway access as well as the exchange of DLT with ET including the common gum elastic bougie. In our institute, the “SGPGI bougie” was developed by the second author which is made with the help of Ryle's tube and three extra-long guide wires (used in laparoscopic renal/urological procedures) are incorporated inside throughout its length [Figure 1]. The distal end is made angulated at a distance of approximately 5 cm at an angle of 100-110° [Figure 1] and its orifices are hermetically sealed. The proximal end is shaven and then hermetically sealed so that no loose end of the guide wire stays outside. Figure 1 Indigenous bougie with arrow showing angulated tip “SGPGI bougie” scores over the conventional gum elastic bougie because it has an increased length of 100 cm as compared to gum elastic bougie which is 60 cm long to accommodate the length of DLT. The bougie/airway guides must be of adequate length to ensure tracheal insertion of the DLT. DLT's of adult sizes (37°F, 39°F and 41°F) are 45 cm long and to exchange them over a bougie additional the length of bougie (>70 cm) is required[3] to provide the required safety margin while railroading the ET and avoid the dislodgement of the bougie [Figure 2]. SGPGI bougie is reusable and can be sterilized either using glutaraldehyde or ethylene oxide. Thus, this device scores on the cost-benefit aspect, especially in resource, crunched set ups. It can be rolled up due to its malleability, and its compactness makes its storage and transportation easier. The presence of an angulated tip and its atraumatic nature are the properties this device shares with the conventional gum elastic bougie. Figure 2 Comparison of length of indigenous bougie with gum elastic bougie Even though various types of indigenous bougies are described in medical literature,[5,6,7,8] our indigenous bougie promises to be an effective alternative to conventional bougie as tube exchanger for DLT with ET. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.