A bougie improves the utility of the UpsherScope

Study Objective: To assess the alignment of the tube-guide and visual-guide channels of the UpsherScope™ and to evaluate methods to improve the success of tracheal intubation. Design: In-vitro observation followed by clinical series. Setting: Tertiary care, academic medical institution. Patients: 56 surgical patients. Measurements and Main Results: In an in-vitro study, cross-marked concentric circles were used as the target for the tracheal tube. It confirmed that the tube-guide channel of the UpsherScope™ directs the tip of the tracheal tube posteriorly and to the right of the visual field when the tube was loaded into the guide channel, according to the manufacturer’s recommendations. Of five other methods used for maneuvering the tracheal tube to the target, use of a bougie within the lumen of the tube resulted in the highest success rate. When this method was assessed in a clinical setting, it was successful in directing the tracheal tube into the trachea of 95% of the patient population. Two failures were due to secretions obscuring the view, and one, to a broken bougie. Conclusions: There is a functional misalignment between the long axes of the tube-guide and visual-guide channels of the UpsherScope™. Use of a bougie will minimize this potential problem.