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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">First of all&#44; we wish to thank G&#243;mez-R&#237;os et al&#46; for their comments&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> and for their interest in our work&#46; Their letter comments on different aspects of our survey&#44; and data from it are used to continue placing emphasis on the existence of major problems in relation to airway management in the critical patient&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We wish to underscore that although there has been an increase in the number of publications in this field in recent years&#44; no specific management guides referred to critical care were forthcoming until the publication in 2017 of the British guidelines by the <span class="elsevierStyleItalic">Difficult Airway Society</span> &#40;DAS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> These guidelines appeared in parallel to our own survey&#59; consequently&#44; we were unable to make any mention of them&#46; Nevertheless&#44; our findings have revealed that there is considerable room for improvement in airway management in the ICU&#59; in this respect&#44; the availability of recommendations for homogenizing such management may have an effect upon critical patient morbidity-mortality&#46; Subsequent studies will be needed to evaluate the impact of these recommendations in routine clinical practice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The evaluation of predictors of difficult intubation is useful in the planning of rescue strategies&#44; making it possible to shorten the intervention times in the event of complications&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The use of combined predictors has been shown to afford increased sensitivity and specificity in detecting a difficult airway compared with the use of a single predictor&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In recent years&#44; some studies have demonstrated the validity of the MACOCHA scale in the ICU<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&#59; nevertheless&#44; the assessment of airway anatomy in the critically ill is usually difficult due to the scarce functional reserve and instability of these patients&#46; Instruments such as the Mallampati scale &#40;included in the MACOCHA scale with a high score&#41; may prove difficult to apply&#46; Despite this&#44; and even in emergency situations&#44; the existence of difficult airway predictors must be taken into account&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Capnography is very important for discarding failed intubation by corroborating correct positioning of the endotracheal tube&#46; Although it is widely used in the intraoperative setting&#44; we admit that the lack of an item asking about the availability of capnography is one of the weaknesses of our survey &#8211; its use having been recommended since the publication of the NAP4&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; while much remains to be done in airway management in the ICU&#44; the fact that recommendations for routine clinical practice are becoming available may imply changes in terms of patient morbidity-mortality&#46; Further studies will be needed to evaluate the impact of these recommendations and to establish new critical airway management protocols&#46;</p></span>"
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Letter to the Editor
Reply to the letter “Airway management in intensive care units”
Respuesta a la carta «Manejo de la vía aérea en las unidades de cuidados intensivos»
M.G. Gómez-Prieto, I. Marmesat-Ríos, J. Garnacho-Montero
Corresponding author
jgarnachom@gmail.com

Corresponding author.
Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">First of all&#44; we wish to thank G&#243;mez-R&#237;os et al&#46; for their comments&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> and for their interest in our work&#46; Their letter comments on different aspects of our survey&#44; and data from it are used to continue placing emphasis on the existence of major problems in relation to airway management in the critical patient&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We wish to underscore that although there has been an increase in the number of publications in this field in recent years&#44; no specific management guides referred to critical care were forthcoming until the publication in 2017 of the British guidelines by the <span class="elsevierStyleItalic">Difficult Airway Society</span> &#40;DAS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> These guidelines appeared in parallel to our own survey&#59; consequently&#44; we were unable to make any mention of them&#46; Nevertheless&#44; our findings have revealed that there is considerable room for improvement in airway management in the ICU&#59; in this respect&#44; the availability of recommendations for homogenizing such management may have an effect upon critical patient morbidity-mortality&#46; Subsequent studies will be needed to evaluate the impact of these recommendations in routine clinical practice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The evaluation of predictors of difficult intubation is useful in the planning of rescue strategies&#44; making it possible to shorten the intervention times in the event of complications&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The use of combined predictors has been shown to afford increased sensitivity and specificity in detecting a difficult airway compared with the use of a single predictor&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In recent years&#44; some studies have demonstrated the validity of the MACOCHA scale in the ICU<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&#59; nevertheless&#44; the assessment of airway anatomy in the critically ill is usually difficult due to the scarce functional reserve and instability of these patients&#46; Instruments such as the Mallampati scale &#40;included in the MACOCHA scale with a high score&#41; may prove difficult to apply&#46; Despite this&#44; and even in emergency situations&#44; the existence of difficult airway predictors must be taken into account&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Capnography is very important for discarding failed intubation by corroborating correct positioning of the endotracheal tube&#46; Although it is widely used in the intraoperative setting&#44; we admit that the lack of an item asking about the availability of capnography is one of the weaknesses of our survey &#8211; its use having been recommended since the publication of the NAP4&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; while much remains to be done in airway management in the ICU&#44; the fact that recommendations for routine clinical practice are becoming available may imply changes in terms of patient morbidity-mortality&#46; Further studies will be needed to evaluate the impact of these recommendations and to establish new critical airway management protocols&#46;</p></span>"
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Article information
ISSN: 21735727
Original language: English
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