Tolerability of the Cook staged extubation wire. A reply

Abstract

We thank Drs Henderson and Cooper et al. for their interest in our research 1. Tracheal extubation strategies have been slow to evolve, especially in intensive care where practice still relies on hope of avoiding re‐intubation. The staged extubation set is yet to be widely adopted and clinician reluctance to use it may stem from either concern over wire intolerance and risk of dislodgement, or its cost and unfamiliarity with its use. Our study should be considered a pilot study that explores the need for wider prospective assessment of its use. We believe the guidewire may be better tolerated than a supraglottic airway for periods of up to 4 h, especially in the intensive care unit setting of trial of extubation for a difficult airway where the risk of delayed re‐intubation is a possibility and a tracheostomy is considered too invasive. We believe the option to purchase the guidewire alone and modifying the circular sheath to make it easier to secure the wire will allow more clinicians to become familiar with the technique and improve it further.