Remember the gum-elastic bougie at extubation

Although the use of a gum-elastic bougie to secure an airway is well described, its use during extubation is not well documented. A bougie was passed through the endotracheal tube (ETT) prior to extubation in anticipation of possible reintubation of a patient with a difficult airway. Once the bougie was in place, the ETT was removed over it. Later, when the patient's airway did become compromised, the trachea was rapidly reintubated using the bougie, without the need for direct laryngoscopy, fiberoptic bronchoscopy, or, worse, emergency tracheostomy.