Difficulties with Gum Elastic Bougie Intubation in an Academic Emergency Department

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• 作者：Kaushal H.  ; Shah MD ; FACEP^&lowast ; ;   ; ^&dagger ; ;   ; ; Brian  ; Kwong MD^&dagger ; ; Alberto  ; Hazan MD^&dagger ; ; Rebecca  ; Batista MD^&dagger ; ; David H.  ; Newman MD^&lowast ; ;   ; ^&dagger ; ; Dan  ; Wiener MD^&lowast ; ;   ; ^&dagger ;
• 关键词：difficult airway ; gum elastic bougie ; emergency department
• 刊名：Journal of Emergency Medicine
• 出版年：2011
• 出版时间：October 2011
• 年：2011
• 卷：41
• 期：4
• 页码：429-434
• 全文大小：436 K

文摘

class=""h4"">Background

The difficulties with gum elastic bougie (GEB) use in the emergency department (ED) have never been studied prospectively.

class=""h4"">Objectives

To determine the most common difficulties associated with endotracheal intubation using a GEB in the ED.

class=""h4"">Methods

We conducted a prospective, observational study of GEB practices in our two affiliated urban EDs with a 3-year residency training program and an annual census of 150,000 patients. Laryngoscopists performing a GEB-assisted intubation completed a structured data form after laryngoscopy, recording patient characteristics, grade of laryngeal view (using the modified Cormack-Lehane classification), reason for GEB use, and problems encountered. Data were analyzed using standard statistical methods and 95 % confidence intervals.

class=""h4"">Results

A GEB was used for 88 patients. The overall success rate was 70/88 (79.6 % ; 95 % confidence interval [CI] 71.1?8.0 % ). The GEB failure rate of the first laryngoscopist was 25/88 (28.4 % ; 95 % CI 21.0?0.3 % ), with the two most common reasons being: inability to insert the bougie past the hypopharynx in 13 (52 % ; 95 % CI 32.4?1.6 % ) and inability to pass the endotracheal tube over the bougie in six (24 % ; 95 % CI 7.3?0.7).

class=""h4"">Conclusions

The GEB is a helpful rescue airway device, but emergency care providers should be aware that failure rates are relatively high at a teaching institution.