Abstract
Airway management is a critical component of emergency and surgical care. In difficult airway scenarios, where clinicians have limited visibility or difficulty accessing the trachea, even small delays in intubation can lead to severe complications or death (Liaqat et al., 2025). Clinicians often rely on bougies to guide endotracheal tube placement, but current designs have remained largely unchanged and present limitations in maneuverability and functionality (von Hellmann et al., 2024). My technical and STS projects are directly connected through the goal of improving safety and effectiveness in airway management while addressing who current technologies are designed for. The technical portion of my thesis focuses on developing a steerable bougie with integrated oxygenation and suction to improve intubation outcomes in high-risk settings. My STS research examines how the underrepresentation of pregnant patients in biomedical research contributes to persistent gaps in maternal airway knowledge and clinical decision-making through the lenses of feminist bioethics and co-production theory. Together, these projects demonstrate that engineering design is shaped by broader research practices and clinical assumptions, highlighting the importance of incorporating STS perspectives into biomedical engineering.
The technical portion of my thesis produced a hollow, steerable bougie designed to improve navigation in difficult airways while integrating oxygenation and suction capabilities. Working with anesthesiologists at UVA Health, my team identified key limitations in existing bougies, including lack of steerability and the inability to provide oxygenation or suction without removing the device. They emphasized that difficult airways are both common and high-risk, contributing to a 49.7% first-attempt failure rate in intubations (Maguire et al., 2023). To address these gaps, we designed a device with dual steering segments controlled by a cable-driven mechanism, allowing for both fine and gross adjustments during use. The device also incorporates a dual-lumen system within a constrained diameter to enable continuous oxygen delivery and suction without interrupting the procedure. These features aim to improve first-attempt success rates, reduce intubation time, and increase reliability in emergency and surgical settings. By focusing on adaptability and real-time control, this design moves beyond conventional bougie designs and provides a more versatile tool for clinicians managing complex airways.
In my STS research, I analyzed how the exclusion of pregnant patients from clinical research and device testing contributes to persistent gaps in maternal airway knowledge and limits the development of pregnancy-specific clinical evidence (Shields & Lyerly, 2013). Using feminist bioethics and Sheila Jasanoff’s co-production framework, I showed that biomedical research practices, device design, and clinical outcomes are mutually shaped rather than independent. Existing literature demonstrates that pregnant patients experience airway changes, including swelling and reduced oxygen reserves, which make intubation more difficult (Bucklin et al., 2008; Mushambi et al., 2015; Hannig et al., 2021). However, pregnant patients are frequently excluded from clinical trials, resulting in limited maternal-specific data to inform device design and clinical guidelines. This lack of data shapes how airway tools are developed, as devices are optimized for general adult populations rather than pregnancy-specific anatomy. These design limitations influence clinical practice, where anesthesiologists must rely on tools that do not fully address these challenges, leading to reliance on extrapolated evidence and uncertainty in decision-making during airway management. These outcomes then reinforce the perception of pregnancy as a high-risk population that is difficult to study, perpetuating its exclusion from future research. This cycle shows that disparities in maternal airway outcomes are shaped by how research, technology, and institutional practices interact.
Together, these projects show that improving airway management requires both technical innovation and critical evaluation of the systems in which technologies are developed and used. My STS research showed me that many of the limitations in current devices come from designing and testing on a narrow range of patients. I used this insight in my technical design by focusing on adaptability and accounting for different airway conditions instead of assuming a standard anatomy. I also recognized that testing should go beyond a single mannequin or ideal scenario and reflect the challenges clinicians face in real settings. By integrating engineering design with STS analysis, this project reinforces the need to design medical devices for a wide range of patients in order to improve safety and address gaps in healthcare.
