To the Editor,

We thank Drs. Thomas, Kelly, and Cook for their interest in our publication and for sharing their experience. As they point out, in spite of a significant increase in the rate of using video laryngoscopy (VL) at our institution over the studied time period of 2002-2013, we use VL to facilitate only a small percentage of tracheal intubations (8-10% from 2012 to 2013). Granted, that figure rises slightly to 10-12% when other alternatives to direct laryngoscopy, e.g., lighted stylet, are also considered.1 We continue to use VL chiefly for anticipated or known situations of difficult direct laryngoscopy or for teaching purposes.

It was interesting to learn that Dr. Thomas et al.2 reported an overall incidence of awake tracheal intubation (about 1%) which is similar to ours.

We look forward to a report from Dr. Thomas et al. some years hence that will clarify whether their universal use of VL has had an impact on the incidence of awake tracheal intubation over a longer time period, or, as with our results, the need for awake tracheal intubation appears to remain relatively fixed.