Preloaded bougie with endotracheal tube over airway

Preloaded vs. Standard Bougie: Which Intubation Technique is Right for You?

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Reese Marlowe in Health & Wellness June 2025 • 4 min read.

"A new study explores the effectiveness of preloaded bougie techniques in emergency intubation, offering insights for medical professionals."


In emergency medicine, securing a patient's airway is a critical, often life-saving, intervention. Endotracheal intubation, the process of inserting a tube into the trachea to assist breathing, is a cornerstone of emergency care. However, difficult airways can present significant challenges, requiring practitioners to be adept at various intubation techniques and the use of airway adjuncts.

One such adjunct is the bougie, a flexible introducer that aids in guiding the endotracheal tube (ETT) into the trachea, particularly when visualization of the vocal cords is obstructed. Traditionally, the bougie is inserted first, followed by the ETT being threaded over it. However, a modified approach, known as the preloaded bougie (PB) technique, involves loading the ETT onto the bougie before insertion. This article will help you understand more about this approach.

A recent study has compared the preloaded bougie technique against the standard bougie technique in a cadaveric model, evaluating success rates, time to intubation, and provider preference. Understanding the nuances of these techniques can empower emergency airway operators to choose the method with which they are most comfortable and proficient.

Preloaded Bougie vs. Standard Bougie: Understanding the Techniques

Preloaded bougie with endotracheal tube over airway

Before diving into the study's findings, it's essential to clarify the two techniques being compared. The standard bougie technique involves first visualizing the glottis with a laryngoscope and then inserting the bougie into the trachea. An assistant then threads the ETT over the bougie, which is subsequently advanced into the trachea. The preloaded bougie (PB) technique, on the other hand, involves pre-positioning the ETT over the bougie before even beginning laryngoscopy. The operator then guides the bougie, with the ETT already in place, through the vocal cords and into the trachea.

The rationale behind the PB technique is to streamline the intubation process by eliminating a step. Instead of inserting the bougie first and then having an assistant thread the ETT over it, the ETT is already in place, ready to be advanced once the bougie is properly positioned. This could potentially save time and reduce the complexity of the procedure, especially in high-pressure emergency situations.

  • Standard Bougie Technique: The bougie is inserted first, followed by the ETT.
  • Preloaded Bougie (PB) Technique: The ETT is pre-positioned on the bougie before insertion.
The study, conducted using a human cadaveric airway model, sought to determine if there was a significant difference in success rates or time to intubation between the two techniques. Researchers also assessed participants' subjective ratings of ease of intubation and their overall preference for one technique over the other. Understanding the methodology used is vital for interpreting the results and considering their implications for real-world clinical practice.

The Bottom Line: Choosing the Right Technique for You

Ultimately, the choice between the standard bougie and preloaded bougie techniques may come down to personal preference and comfort level. Both techniques have proven effective in securing airways during emergency intubation. Emergency airway operators should feel confident in using the technique with which they are most comfortable, and proficient in both methods.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5811/westjem.2015.4.22857, Alternate LINK

Title: Comparison Of Preloaded Bougie Versus Standard Bougie Technique For Endotracheal Intubation In A Cadaveric Model

Subject: General Medicine

Journal: Western Journal of Emergency Medicine

Publisher: Western Journal of Emergency Medicine

Authors: Jay Baker, Kevin Maskell, Aaron Matlock, Ryan Walsh, Carl Skinner

Published: 2015-07-15

Everything You Need To Know

1

What does the standard bougie technique involve in endotracheal intubation?

The standard bougie technique involves first visualizing the glottis with a laryngoscope and then inserting the bougie into the trachea. An assistant then threads the ETT over the bougie, which is subsequently advanced into the trachea. This method has been used for a longer period of time compared to the preloaded version.

2

How does the preloaded bougie (PB) technique differ from the standard bougie technique?

The preloaded bougie (PB) technique involves pre-positioning the ETT over the bougie before even beginning laryngoscopy. The operator then guides the bougie, with the ETT already in place, through the vocal cords and into the trachea. This technique aims to streamline the intubation process, potentially saving time during emergency situations.

3

Why are both bougie techniques important in emergency airway management?

In emergency medicine, difficult airways can present significant challenges. Both bougie techniques help in guiding the endotracheal tube (ETT) into the trachea, particularly when visualization of the vocal cords is obstructed. The preloaded bougie technique's potential to save time can be crucial in critical situations.

4

How should emergency airway operators decide between using the standard bougie and preloaded bougie techniques?

The choice between the standard bougie and preloaded bougie techniques may come down to personal preference and comfort level. Emergency airway operators should feel confident in using the technique with which they are most comfortable, and proficient in both methods. Factors like the operator's experience and the specific clinical scenario can influence this choice.

5

What type of study was done to compare the effectiveness of these two bougie techniques?

A study used a human cadaveric airway model to determine if there was a significant difference in success rates or time to intubation between the two techniques. Researchers also assessed participants' subjective ratings of ease of intubation and their overall preference for one technique over the other. The study highlights the importance of understanding the nuances of each technique.

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