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LETTERS TO EDITOR
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 199-200
 

A bougie as a foreign body


Department of Anaesthesia and Critical Care, Safdarjung Hospital, New Delhi, India

Date of Submission11-Oct-2020
Date of Acceptance05-Jan-2021
Date of Web Publication29-Sep-2021

Correspondence Address:
Dr. Mahak Kakkar
Department of Anaesthesia and Critical Care, Safdarjung Hospital, Ansari Nagar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_161_20

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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

How to cite this URL:
Kakkar M, Guria S, Jain S, Bairagi S. A bougie as a foreign body. Indian Anaesth Forum [serial online] 2021 [cited 2021 Dec 7];22:199-200. Available from: http://www.theiaforum.org/text.asp?2021/22/2/199/326971




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 Top

1.
Sharma ML, Bhardwaj N, Chari P. Broken metal intubating stylet. Anaesth Intensive Care 1994;22:624.  Back to cited text no. 1
    
2.
Robbins PM. Critical incident with gum elastic bougie. Anaesth Intensive Care 1995;23:654.  Back to cited text no. 2
    
3.
Hambly PR, Field JM. An unusual case for reintubation. Anaesthesia 1995;50:568.  Back to cited text no. 3
    
4.
Dorsch JA, Dorsch SE. Tracheal tube and associated equipment. In: Understanding Anaesthesia Equipment. 5th ed.. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2008. p. 605.  Back to cited text no. 4
    


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