Ultrasound versus fiberscope-guided tracheal intubation
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To the Editor:
I would like to thank Wang et al.  for their interest in our study comparing the fiberscope and the ultrasound guided techniques for tracheal intubation in patients with cervical spine immobilization. Actually, in the technique described in the study, the rigid neck collar was removed before tracheal intubation to shape the tracheal tube mounted over the stylet according to the previous lateral view X-ray taken in the neutral position. However, some types of cervical neck collars are available having a front window that allow ultrasound examination of the airway.
I agree with Wang et al.  that the experience in ultrasound-guided tracheal intubation is critical for its success. The operator in the ultrasound group has been stated to have 7 years of experience in the application of ultrasound in the airway and the intensive care including confirmation of tracheal intubation. The operator also observed the performance of the technique in 20 cases before the beginning of the study; however, they were not belonging to the population of the present study. A number of our staff members have been now well trained with technique and a large study is now being processed on a wide variety of patients.
MAM: idea of the research, writing the final draft, performing the design of the research. EAA: participation in the design, collection of data. OMZ: statistical analysis, participation in the protocol, collection of data.
Compliance with ethical standards
This study was conducted with written informed consent from the study subjects.
All authors have no financial support and potential conflicts of interest for this work.
Conflict of interest
The author(s) declare that they have no competing interests.
This report describes human research. IRB contact information: Ethics Committee of the Alexandria Main University Hospitals, 16/6/2011, IRB NO: 00007555-FWA NO: 00015712.