The Difficult Airway in Adult Critical Care

Gavin G. Lavery, MD, FCARSCI, MB, BCh, BAO; Brian V. McCloskey, MB, BCh, FRCA, FFARCSI, MRCP


Crit Care Med. 2008;36(7):2163-2173. 

In This Article

Stylet ('Introducer') and Gum Elastic Bougie

The stylet is a smooth, malleable metal or plastic rod that is placed inside an ETT to adjust the curvature, typically into a J or hockey stick shape to allow the tip of the ETT to be directed through a poorly visualized or unseen glottis.[97] The stylet must not project beyond the end of the ETT to avoid potential airway injury. In contrast, the gum elastic bougie is a blunt-ended, malleable rod that may be passed through the poorly or nonvisualized larynx by putting a J-shaped bend at the tip and passing it blindly in the midline upward beyond the base of the epiglottis. The ETT can then be railroaded over the bougie, which is then withdrawn. For many, it is the first choice adjunct in the difficult intubation situation.[91,98] There has been much debate regarding the relative merits of the bougie (used widely in the United Kingdom) and stylet (more popular in North America).[99,100]


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