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We have read the correspondence (1) discussing some issues in our recently published article in Pediatric Critical Care Medicine (2). We are very appreciative of your interest in our article. We would like to answer your concerns as follows. First, our study (2) was a randomized, double-blind, placebo-controlled trial study so that it could reduce the observer bias. We agree with Dr. Ismail (1) that the fluticasone group received more nebulized epinephrine than placebo group. Nebulized epinephrine might be one of the treatments of postextubation stridor (PES) (3). However, the primary and secondary outcomes (PES, reintubation rate) were not different in both groups. In addition, the fluticasone group had a longer noninvasive positive pressure ventilation (NIPPV) initiation time and longer time to first dose of epinephrine than the placebo group. Second, as you mentioned the time to first dose of epinephrine and time to start of NIPPV were not statistically significant between the two groups likely because of shorter duration of ventilator and better management of PES. We agree with this explanation since the mean duration of intubation in our study (3) was only 28 hours compared with a prior study (4). The prevalence of airway edema would be low. In our opinion, although there was not clinically significant in terms of using fluticasone to prevent PES, it might be benefit in emergently intubated patients. Further studies are recommended to confirm the result. We hope that our response helps to answer your questions.

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