Difficult tracheal intubation of in-hospital emergent patients.

skip to the next step of the difficult airway management algorithm.” Because of these standards, we did not measure intubation or apnea times. We thank Xue et al. for their pertinent propositions, some of them being currently applied for several years. We have responded to three issues of Shetty et al. in our response to Xue et al. We have precisely defined exclusion/ inclusion criteria including fiberoptic tracheal intubation indications in the methods section of our trial. There is no upper limit in the number of predictors to exclude the patient or to propose fiberoptically tracheal intubation. The fourth issue from Shetty et al. deserves short explanations. The CL in the three patients intubated with the combination of the Airtraq (Vygon, Ecouen, France) and GEB cannot be scored properly. In these patients the glottis was visible (CL 1) but the larynx was sitting laterally far from the distal tip of the blade, and a long and narrow partially floppy epiglottis misdirected systematically the endotracheal tube into the pyriform fossae. We had observed that in two circumstances GEB dramatically shortened and simplified tracheal intubation with the AirtraqTM laryngoscope: in the presence of an abnormally distant larynx, the Sellick maneuver is applied. Then in these cases we use GEB to shorten tracheal intubation with the AirtraqTM laryngoscope. We have recorded videos of such maneuvers we could send to Shetty et al. During this maneuver the AirtraqTM position is stabilized in optimal best position, the endotracheal tube is rearmed in the channel (but not pushed) toward the glottis. GEB is passed through the endotracheal tube armed in the channel. Then manipulations of the distal tip of GEB in combination with soft changes in AirtraqTM position permits tracheal access and endotracheal tube railroading. We agree with Shetty et al. that we should have described this maneuver more extensively. We are ready to publish a case series demonstrating the value of GEB in case of difficult AirtraqTM intubation.