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| LETTERS TO EDITOR |
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| Year : 2021 | Volume
: 22
| Issue : 2 | Page : 199-200 |
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A bougie as a foreign body
Mahak Kakkar, Sushil Guria, Swati Jain, Sushmita Bairagi
Department of Anaesthesia and Critical Care, Safdarjung Hospital, New Delhi, India
| Date of Submission | 11-Oct-2020 |
| Date of Acceptance | 05-Jan-2021 |
| Date of Web Publication | 29-Sep-2021 |
Correspondence Address:
Dr. Mahak Kakkar
Department of Anaesthesia and Critical Care, Safdarjung Hospital, Ansari Nagar, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/TheIAForum.TheIAForum_161_20
How to cite this article:
Kakkar M, Guria S, Jain S, Bairagi S. A bougie as a foreign body. Indian Anaesth Forum 2021;22:199-200 |
Sir,
Bougies are used for handling difficult airway situations. Rarely, it may break inside the trachea. We report a case of 58-year-old, 140 kg female who was admitted in the intensive care unit with a diagnosis of diabetic ketoacidosis with sepsis and acute respiratory distress syndrome along with obstructive sleep apnea, hypertension, and morbid obesity.
Patient had difficulty in ventilation owing to endotracheal tube blockade (ETT) which was exchanged using a gum elastic bougie. A new endotracheal tube, size 7.0 mm, was railroaded over the bougie after withdrawing the already present ETT. During withdrawal, the bougie fractured, and a part was left inside the patient's airway, though the ventilation was maintained through the new endotracheal tube.
The patient was immediately shifted to emergency operating room for removal of the distal fore. She was monitored with electrocardiogram, noninvasive blood pressure, peripheral oxygen saturation, and end-tidal CO2. She was given injection fentanyl 50 μg and was put on volume control mode ventilation with a positive end-expiratory pressure of 10 cm water. Attempt was done using a pediatric bronchoscope, as size was restricted by the size of ETT in situ. The smaller size forceps failed to grasp the bougie segment because of the relatively larger diameter of bougie and lack of space between the bougie and inner wall of ETT. After multiple failed attempts using ventilating rigid pediatric bronchoscope through forceps, a tracheostomy was performed due to deteriorating ventilation. The visible fractured distal part of bougie [Figure 1]a was removed through the tracheostome [Figure 1]b using surgical forceps. Length of the bougie inside the trachea was measured to be 17.5 cm [Figure 1]c. | Figure 1: (a) Distal end of bougie visible through the endotracheal tube on video bronchoscope; (b) removal through tracheostome; (c) length of removed bougie – 17.5 cm
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Iatrogenic tracheobronchial foreign bodies are a rare presentation. In our case, a fractured distal segment of bougie was retained inside the patient's airway. Other reports of iatrogenic foreign bodies include ETT stylet, suction catheter tips, ETT fragments, and other catheters.[1],[2] Hambly and Field[3] had reported the use of bougie for tube exchange. A bougie with a straight tip can be used for tube exchange.[4]
The equipments that we use in case of anticipated difficult airway such as a bougie, or airway exchange catheter should be checked for their strength on regular basis. A departmental protocol should be made regarding checking of such equipment so that further mishaps can be avoided. Furthermore, ENT surgeon should always be there for procedures such as these in anticipated difficult airways.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Sharma ML, Bhardwaj N, Chari P. Broken metal intubating stylet. Anaesth Intensive Care 1994;22:624.  |
| 2. | Robbins PM. Critical incident with gum elastic bougie. Anaesth Intensive Care 1995;23:654. |
| 3. | Hambly PR, Field JM. An unusual case for reintubation. Anaesthesia 1995;50:568. |
| 4. | Dorsch JA, Dorsch SE. Tracheal tube and associated equipment. In: Understanding Anaesthesia Equipment. 5 th ed.. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2008. p. 605. |
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