Bibliographic record
Abstract
We would like to thank the authors for their replies regarding our study [1]. We appreciate Curtis’s words of caution concerning potential complications when using the videolaryngoscope for awake intubation of the morbidly obese. The most commonly reported complication of videolaryngoscope-assisted intubation in anaesthetised patients is laceration or perforation of the palate or tonsil during tube insertion [2, 3], but we were unable to quantify this risk in our study. To our knowledge, no complications of this technique have been reported in conscious patients thus far, but this is most likely to reflect its limited implementation, as all other types of intubation technique are associated with airway trauma. To limit the risk of injury to the airway during our study, we did not persist with videolaryngoscopy if severe coughing/gagging occurred during insertion, but provided additional topical anaesthesia and sedation, before any further attempt was made. We agree that awake patients may be at increased risk of palatal trauma secondary to coughing/gagging, but they may be relatively protected from the same by being able to indicate pain or discomfort during tracheal tube insertion (depending on the level of sedation and airway anaesthesia). We also agree with Curtis that passing the tracheal tube through the vocal cords using a videolaryngoscope can be just as difficult as obtaining a view of the vocal cords. One patient in our study was given general anaesthesia after obtaining a videolaryngoscopic view of the vocal cords because attempted passage of the tube caused severe coughing and gagging. Although there is evidence that a good view of the vocal cords during conventional ‘awake look’ laryngoscopy persists after induction of general anaesthesia [4], this is not necessarily the case during videolaryngoscopy. We do not advocate a videolaryngoscopic ‘awake look’ before tracheal intubation, but suggest this method could provide the anaesthetist with useful information when determining definitive airway management. We appreciate Richardson and Hodzovic’s comments concerning the range of videolaryngoscopes that might be used to assist awake intubation, and how the blade design of each may variably affect the prevalence of difficulties encountered when performing this technique. It remains unclear if there is one ideal laryngoscope for awake tracheal intubations. We chose to use the Glidescope® for our study based solely on its availability in our department and our comfort and experience with its use, but agree that our results may have been different using other videolaryngoscopes with which we were less familiar. Further research is clearly required to evaluate and compare the strengths and weaknesses of the various methods and equipment used for awake tracheal intubation.
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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 | 0.006 | 0.091 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.013 | 0.021 |
| Insufficient payload (model declined to judge) | 0.047 | 0.032 |
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".