Bibliographic record
Abstract
The authors are to be congratulated for comprehensive and practical guidelines on an important topic [1]. We agree that re-intubation over an airway exchange catheter (AEC) can be a complex procedure. A small calibre (11-FG) AEC provides patient comfort and tolerability, but renders the relatively flimsy AEC prone to posterior displacement as the larger and stiffer adult tracheal tube is advanced during re-intubation, such that the tube may snag on the corniculate/arytenoid cartilages. However, the Difficult Airway Society (DAS) guidelines fail to mention intermediate use of an Aintree intubation catheter (William Cook Europe, Bjaeverskov, Denmark) during re-intubation. Whilst not appropriate for primary use as an AEC at extubation due to its larger (19-FG) diameter and stiffness, these same attributes temporarily stiffen and enlarge an 11-FG AEC (Fig. 1) during re-intubation, allowing for easier railroading of a the tube, with less likelihood of snagging. Intermediate use of an Aintree intubating catheter over an 11-FG airway exchange catheter minimises tracheal tube hold-up on glottic soft tissues. In addition, mismatch between the external diameter of the small AEC and the internal diameter of the larger tracheal tube leaves a ‘lip’ of tracheal tube that can snag on glottic structures. Previous authors have recommended the use of a tracheal tube with a ‘beaked’ leading edge to avoid this problem [2]. The DAS guidelines advise railroading a tube with the bevel facing anteriorly, achieved by clockwise rotation of the tube by 90 degrees from the beaked position, but this risks snagging. We suggest that counterclockwise rotation of the tube by 90 degrees over an AEC, with the bevel facing posteriorly, is more likely to avoid this problem [3].
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.022 | 0.020 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".