Rapid Sequence Intubation and Use of the Bougie for Penetrating Neck Injury

The airway management of patients presenting to the emergency department (ED) with penetrating neck injuries has wide practice variation. There is no general agreement on a standard method of intubation for these patients, and no practical data regarding the safety or efficacy of the bougie tracheal tube introducer in this population.

The aim of this study was to describe the outcomes and complications of tracheal intubation with routine bougie use in patients presenting with penetrating neck injuries. The primary outcome was first-attempt success.

This was a retrospective chart review of any patient who presented to the ED in a 12-year study period with penetrating neck trauma and received tracheal intubation. After patients were identified, manual chart review was used to collect data on patient demographics, injury patterns, airway management strategy, first-attempt success, and complications. The data was analyzed using descriptive statistics.

88 patients were included in the study. Of these, 84 (95%) patients were intubated with facilitation of a neuromuscular blocking agent, with 87 (99%) undergoing orotracheal intubation. A bougie was used in 64 patients (73%). first-attempt success was achieved in 83 patients (95%). All patients were intubated via an orotracheal route successfully in the ED except one who underwent a surgical airway as the initial approach. No iatrogenic airway injury was observed.

Rapid sequence intubation with bougie use was an effective default approach to definitive airway management in ED patients with penetrating neck trauma.