A reply

Abstract

Although we do not disagree with Drs Thomas and Cook about the inherent benefits of using the LMA ProSeal (PLMA) over the LMA Classic (cLMA), we do not share their enthusiasm for its use in the ICU setting. We would be unlikely to use any laryngeal mask airway device routinely for bronchoscope-guided percutaneous tracheostomy or as a planned bridge to extubation during problematic weaning because we fail to see any proven benefit. The use of such devices has a financial cost, as well. We used the cLMA in ICU as a short-term emergency measure to break a cycle of repeated tracheal intubations in a postsurgical, semiconscious, super-morbidly obese patient in whom we were desperate to avoid prolonged ventilation for obvious reasons. We were not concerned about aspiration or gas leak around the laryngeal mask airway seal or into what remained of the stomach following gastric bypass surgery, as we knew this to be empty and we were only delivering a maximum 20 cmH2O of continuous positive airway pressure to a spontaneously breathing patient. Our main concern was keeping the patient's airway patent, for which the cLMA proved perfectly adequate. In fact, given a choice (which we don't have at present) we would have probably still have opted for cLMA as this is familiar and should be easier to insert, particularly in an un-anaesthetised patient. We will, however, take on board their comments and if the situation arises where we require the additional performance of the PLMA, we will endeavour to use it.