In reply: Definitive airway management in emergency department patients with a King laryngeal tube™ in place: a simple and safe approach.

Abstract

To the Editor, We thank Dr. Dodd et al. for their interest in our manuscript and sharing their experience. They describe an alternate, equally safe, controlled technique using a video laryngoscope-guided exchange with excellent results. We agree that a video laryngoscope-guided technique has the advantage of familiarity and simplicity. During the time of our study, however, video laryngoscopy was still being introduced into clinical practice. In our report, we also described a safe technique for exchanging the King LT(S)D laryngeal tube (King LT) for a standard endotracheal tube utilizing an Arndt exchange catheter. The circumstances surrounding King LT use (e.g., suboptimal conditions encountered in the field, venous and lymphatic compression resulting from the oropharyngeal cuff, duration of use) contribute to airway edema. Given our patient’s demographics and location, considerable time may have elapsed during transport prior to definitive airway management, possibly resulting in a greater degree of airway edema influencing the final technique. No one technique has been shown to be superior in making this exchange. Given patientand case-specific variables, available equipment and experience, and comfort and experience of the bedside clinicians, it is prudent to have multiple techniques and options available when exchanging a King LT, two of which are described in this commentary.