In a patient w/ a trach who is now hypoxic and/or the trach is malfunctioning a bougie may potentially be passed through the trach directed cephalad, once the provider who is at the head and performing direct laryngoscopy is able to visualize the bougie he may “grasp” it w/ a clamp to pull it out of the mouth and then pass the endotracheal tube using the bougie as a guide knowing it will go into the trachea.

It is important to have ENT at bedside with these patients and remember to attempt in-line suction prior to this procedure as mucus/clots are often the cause of obstruction.

The technique is similar to a guide-wire retrograde intubation depicted in the following video:

Retrograde guide-wire intubation