In Reply.—There is merit in some, but not all, of Dr Poulton's criticisms. Our report1 on bacterial tracheitis did not detail the exact circumstances of every patient whose case we reported, and these circumstances have some bearing on Dr Poulton's comments. In our article, we combined all of the complications encountered by these children, both before and while being treated in our pediatric intensive care unit.
The two deaths Dr Poulton mentioned were tragedies that led us to review and revise extensively our intensive care protocols. These deaths represent the only deaths from inflammatory airway disease in our pediatric intensive care unit during the last ten years. It is more than a coincidence that both of these deaths were associated with bacterial tracheitis. It was not until after we appreciated the seriousness of bacterial tracheitis that a protocol was developed to cope adequately with this disease.