Successful use of the airway management device.

The reason for using peak as distinct from plateau pressure in our study was pragmatic, and related to the fact that nurses on the intensive care units in question were already documenting peak, but not plateau, pressure at the time of the study's inception. Peak inspiratory pressure was felt to provide a reasonable surrogate marker for the degree of barotrauma. It is worth stressing that the speci®c measures and cutoff values utilized in our study were all chosen for pragmatic reasons: it would be reasonable to argue that the cutoff values were not suf®ciently stringent, but these were chosen, before starting the study, based on what it was thought it would be reasonable to achieve in a ®rst audit cycle. There is no reason why audit`targets' should not move with successive audit cyclesÐindeed, this seems to have been employed with some success by the Department of Health. The purpose of our article is to propose a simple audit method rather than precise parameters or cutoff valuesÐeven with available clinical data these must still be open to debate. (ii) We agree with Drs Hunter and Rothwell that intensive care nurses have a pivotal role to play in the modernization of clinical practice on intensive care units. Indeed, we made this point in our paper. The use of a computer-generated protocol to guide ventilation practice is intriguing, though we utilized a less detailed approach, concentrating on getting the fundamentals of ventilatory care correct. (iii) Given that the main thrust of our article related to an audit method to assess ventilation practice, we should be interested to ®nd out what methods were used to audit the effects of Drs Hunter and Rothwell's computer-driven nurse protocol. method to evaluate the practice of positive pressure ventilation in intensive care units. Br J Anaesth 2003; 91: 419±20 2 Anonymous. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. EditorÐWe refer to the correspondence by Stacey and colleagues 1 regarding the modi®ed airway management device (AMD). We would like to share our experience in using the recently introduced version of the AMD, which has design changes. Our results are very different from those reported by Stacey and colleagues. In our recently concluded study, insertion of the AMD was easy and atraumatic. Successful insertion with adequate ventilation was possible in all 50 cases. The AMD was …