title: Bougie-related airway trauma: dangers of the hold-up sign.
abstract: The bougie is a popular tool in difficult intubations. The hold-up sign is used to confirm tracheal placement of a bougie. This study aimed to establish the potential for airway trauma when using this sign with an Eschmann re-usable bougie or a Frova single-use bougie. Airways were simulated using a manikin (hold-up force) and porcine lung model (airway perforation force). Mean (SD) hold-up force (for airway lengths over the range 25-45 cm) of 1.0 (0.4) and 5.2 (1.1) N were recorded with the Eschmann and Frova bougies, respectively (p < 0.001). The mean (SD) force required to produce airway perforation was 0.9 (0.2) N with the Eschmann bougie and 1.1 (0.3) N with the Frova bougie (p = 0.11). It is possible to apply a force at least five times greater than the force required to produce significant trauma with a Frova single-use bougie. We recommend that the hold-up sign should no longer be used with single-use bougies. Clinicians should be cautious when eliciting this sign using the Eschmann re-usable bougie.
authors.affiliation: Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff University, Cardiff, UK.
authors.forename: B A
authors.initials: BA
authors.lastname: Marson
authors.forename: E
authors.initials: E
authors.lastname: Anderson
authors.forename: A R
authors.initials: AR
authors.lastname: Wilkes
authors.forename: I
authors.initials: I
authors.lastname: Hodzovic
mesh_terms: D058109:Airway Management / Q000009:adverse effects* / Q000295:instrumentation*; D000465:Algorithms; D000704:Analysis of Variance; D000818:Animals; D004209:Disposable Equipment; D017743:Equipment Reuse; D007431:Intraoperative Complications / Q000175:diagnosis*; D007442:Intubation, Intratracheal / Q000295:instrumentation; D013552:Swine; D014132:Trachea / Q000293:injuries*