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DAS guidelines on the airway management of critically ill patients

using traditional laryngoscopy methods as a part of a treatment algorithm [4]. The ‘before’ group in our study included patients treated before implementation of the rapid sequence induction protocol. The majority of these intubations were performed with traditional Macintosh laryngoscope and a stylet. The C-MAC videolaryngoscopy and a bougie were available, but most physicians considered them to be rescue devices. Unfortunately, we do not have precise data on the intubation techniques in the control group. The question about comparing C-MAC and bougie or stylet is challenging. The sample size required to compare these would be very large, as the treatment effect (i.e. failure to intubate at the first attempt using our protocol) is very small. Using observational registry data instead is likely to be confounded by multiple variables. We agree that the focus of developments in airway management is moving from cord visualisation towards efficient and safe advancement of the tracheal tube. We chose the Frova introducer for our protocol for its special features (relative stiffness, controllability, visibility), which enable the laryngoscopist to identify the trachea in suboptimal visual conditions by feeling the ‘clicks’ transmitted when crossing tracheal rings, and the distal hold-up or cough signs [5]. Sparrow et al.’s new technique looks interesting, and we are looking forward to the formal presentation of their data. S. Angerman J. Nurmi Helsinki University Hospital, Helsinki, Finland Email: susanne.angerman-haasmaa@hus.fi