We thank Sundaram et al for their interest in our published study; they raise several important points that deserve discussion. With regards to their first point, direct laryngoscopy (DL) is unequivocally the gold standard for confirming endotracheal tube (ETT) placement. DL is not always possible, and ETTs can slip out of place before being secured or move during transport. Colorimetric end-tidal carbon dioxide detection (CECD) remains the standard for secondary confirmation of ETT position in the trachea. We propose the use of both CECD and bedside ultrasonography (BUS), along with DL and clinical examination, to confirm ETT placement.

Regarding their second question, as to whether the ETT may have actually been esophageal in the 2 patients with severe bronchospasm, both of these patients were reintubated twice under DL in exactly the same manner. The ETT was seen passing through the vocal cords in each instance, and...

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