What is a bougie in a hospital?

September 23, 2025 •

4 min read

According to a 2018 study in JAMA, the use of a bougie significantly increased first-attempt intubation success rates in emergency department patients with difficult airways. A bougie in a hospital is a simple yet crucial medical device used to aid in securing a patient's airway, especially during challenging situations.

Quick Summary

A bougie is a flexible, long introducer used during endotracheal intubation to guide the breathing tube into a patient's trachea when direct visualization is limited. Its use improves first-attempt success rates in difficult airway scenarios, which can significantly impact patient outcomes during critical procedures.

Key Points

Endotracheal Tube Introducer: A bougie is a flexible guide used to assist with the placement of a breathing tube into the trachea, a process known as intubation.
Difficult Airways: It is especially critical for 'difficult airways' where the clinician has limited visualization of the patient's vocal cords, which can be due to anatomy or injury.
Tactile Confirmation: Even with poor visibility, the clinician can often feel the bougie's tip clicking over the patient's tracheal rings, confirming correct placement.
Angled Tip: The bougie features a specially angled tip that helps steer it into an anteriorly positioned trachea, circumventing anatomical challenges.
Alternative to a Stylet: Unlike a rigid stylet that simply stiffens the tube, the bougie acts as a standalone guide, offering superior navigation in specific complex cases.
Minimizing Complications: While a powerful tool, proper training is essential to avoid potential complications such as airway trauma or perforation.

Understanding the Medical Bougie

In a hospital setting, a bougie is an endotracheal tube introducer, a semi-rigid device that looks like a long, thin, flexible rod. Historically, the term is derived from a French word meaning 'candle,' and early versions were indeed candle-shaped. The modern bougie, however, is a sophisticated piece of medical equipment, typically made of plastic, with a distinct, angled tip (often around 35-40 degrees) designed to help navigate the anatomy of the airway. This slight bend, known as a 'coude' tip, allows the user to steer the device around obstructions and into the trachea. It is a standard component of most difficult airway carts in emergency departments and intensive care units.

The Bougie’s Primary Function

The bougie's main purpose is to facilitate the placement of an endotracheal tube, the breathing tube that is inserted to provide mechanical ventilation. The procedure, called endotracheal intubation, can be challenging when the clinician's view of the vocal cords (the glottis) is partially or completely obscured. The bougie is first inserted into the trachea, and then the endotracheal tube is "railroaded" over it into the correct position.

The Role of a Bougie in Difficult Intubation

Difficult intubation is a critical scenario in which a patient's anatomy, or their medical condition, makes placing the breathing tube exceptionally challenging. Such cases can occur due to limited neck mobility, an anterior airway, or other factors. The bougie serves as a guide for these situations, offering several distinct advantages:

Provides a tactile confirmation: The clinician can often feel subtle 'clicks' or 'speed bumps' as the bougie's tip passes over the patient's tracheal rings, providing a crucial indicator of correct placement even without a full view.
Helps navigate the anatomy: The angled tip is designed to be maneuvered into an anteriorly positioned trachea, where a straight endotracheal tube might fail.
Offers procedural flexibility: For procedures using a supraglottic airway device, a bougie can sometimes be inserted through the device to secure the airway.

How is a Bougie Used During Intubation?

Preparation: The clinician prepares the bougie and the endotracheal tube. The patient is positioned appropriately, and the laryngoscope is used to obtain the best possible view of the glottis.
Insertion: With the glottis visible, even if partially, the bougie is gently inserted and directed towards the trachea, often hugging the underside of the epiglottis.
Confirmation: The clinician uses tactile feedback to confirm tracheal placement. Feeling the tracheal rings or encountering resistance as the tip reaches a main bronchus ('hold up') are key indicators. No hold-up suggests esophageal placement.
Advancement: Once confirmed, an assistant passes the endotracheal tube over the bougie and into the trachea. The bougie is then carefully removed, leaving the endotracheal tube in place.
Final Checks: As with all intubations, confirmation of tube placement via capnography and auscultation is performed.

Types of Bougies in Clinical Practice

While the gum elastic bougie (GEB) is the most well-known, other devices with similar functions exist. For example, some devices have advanced features like integrated video. Bougies are also used in other medical specialties, such as gastroenterology, for esophageal dilation.

Bougie vs. Stylet: A Comparison

Bougies are often compared to stylets, another device used during intubation. While they share the goal of aiding endotracheal tube placement, their mechanisms and ideal use cases differ significantly.


Feature	Bougie	Stylet
Flexibility	Highly flexible and semi-rigid	Malleable, but more rigid than a bougie
Primary Function	Acts as a guide or introducer for the ETT	Straightens and stiffens the ETT for easier insertion
Key Advantage	Offers tactile confirmation of tracheal rings, ideal for poor visualization	Allows for shaping the ETT to a desired curve, useful for routine cases
Use Case	Difficult airways where glottic view is limited	Standard intubations or when a specific curve is needed for navigation
Tactile Feedback	Distinct clicks and hold-up sign are possible	No tactile feedback of tracheal rings

Potential Complications and Considerations

While a highly valuable tool, bougie use is not without risks, especially for less experienced clinicians. Potential complications include:

Airway Trauma: Injury to the tracheal mucosa or pharynx can occur, though it is usually minimal due to the device's flexibility.
Tracheal or Bronchial Perforation: In rare cases, especially with single-use devices or if excessive force is used, perforation of the trachea or a bronchus can lead to serious complications like a pneumothorax.
Esophageal Perforation: Though rare, advancing the bougie too far into the esophagus can cause injury.
Misplacement: Even with the bougie, misplacement can occur. Confirmation techniques are crucial.

Healthcare providers must be well-trained in its proper use to maximize the bougie's benefits and minimize risks. Following established protocols and using techniques like the 'hold-up' sign responsibly are essential. One notable case report highlights the severity of bougie-associated bronchial injury, emphasizing the need for care during the procedure one such case report.

Conclusion: The Bougie's Importance in Airway Management

In summary, a bougie is a flexible, semi-rigid endotracheal tube introducer that is indispensable in the modern hospital, particularly in emergency and critical care settings. It plays a critical role in managing difficult airways by providing a reliable guide for the placement of a breathing tube, often when direct visualization is challenging. By understanding its function, proper technique, and potential risks, healthcare professionals can effectively leverage this simple device to improve patient safety and increase the success of vital intubation procedures. Its value as a first-line tool for difficult intubations is widely recognized, cementing its place in the toolkit of any skilled airway manager.

Frequently Asked Questions

When a bougie is correctly inserted into the trachea, the clinician can feel distinct tactile sensations. This includes a series of 'clicks' or 'speed bumps' as the tip passes over the tracheal rings, and a 'hold up' sign, which is gentle resistance felt when the bougie meets the narrower bronchi.

While the term 'bougie' can historically refer to dilators for various bodily passages, the modern device used for intubation is distinct from urinary catheters. A different type of bougie, or bougie catheter, is used in procedures involving the urinary bladder or urethra.

A doctor would typically choose a bougie when faced with a potentially difficult airway where they have a limited view of the glottis. A stylet is often used for routine intubations to stiffen the tube, but the bougie's flexibility and tactile feedback are superior for navigating complex anatomies.

Yes, bougies come in different sizes to accommodate various patient types, including pediatric and adult. Some manufacturers also produce different types with specialized tips or markings.

While it was historically used as a 'rescue' device for difficult airways, recent studies and expert recommendations have suggested incorporating the bougie into a primary intubation strategy, especially in emergency departments.

Though generally safe in trained hands, improper technique can lead to complications. Risks include minor airway trauma, and in rare cases, tracheal or bronchial perforation.

Correct placement is primarily confirmed through the tactile feel of the tracheal rings and the 'hold up' sign. After the endotracheal tube is placed, confirmation is also done using standard methods like capnography and lung auscultation.