We are grateful for the consensus recommendations on preventing unrecognized esophageal intubation provided by the Project for Universal Management of Airways (PUMA) group. These give precise instructions on how to avoid, recognize, and treat esophageal intubation, which up until now was largely left to individual experience and judgement. We have a few points about the paper that we would want to address. Priority should be given to proactively excluding esophageal insertion after tracheal intubation in order to reduce gastric insufflation should the tube be inserted in the esophagus. The PUMA group advises that in order to confirm that a well-positioned tube is still in the trachea, we should look for continued good exhaled carbon dioxide waveforms (at least seven).
