==== Front Ann Intensive Care Ann Intensive Care Annals of Intensive Care 2110-5820 Springer International Publishing Cham 33263860 779 10.1186/s13613-020-00779-0 Letter to the Editor SORT as any easy technique to do; but needs more trials to be as a routine practice Sanaie Sarvin 1 http://orcid.org/0000-0002-4361-6230Mahmoodpoor Ata amahmoodpoor@yahoo.com 23 1 grid.412888.f0000 0001 2174 8913Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran 2 grid.412888.f0000 0001 2174 8913Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 3 General ICU, Shohada Hospital, El-Goli Street, Tabriz, Iran 2 12 2020 2 12 2020 2020 10 16223 10 2020 21 11 2020 © The Author(s) 2020Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.issue-copyright-statement© The Author(s) 2020 ==== Body Najafi has published a letter about our published article regarding the comparison of SORT maneuver versus a conventional technique of neck flexion lateral pressure (NFLP) for nasogastric tube (NGT) insertion in ICU admitted patients [1]. He mentioned that there is a lack of standard definitions for the favorable outcome like the time span attributable to “ease of insertion” and the determinants for “insertion failure”. However, we tried to change the ease of insertion with our grading score which made it so easy to compare. We evaluated the ease of insertion with a 4-grade score as following: first grade as successful insertion in less than 50 s and in the first attempt, second grade as successful insertion in the first attempt with more than 50 s or in the second attempt with less than 100 s, third grade as successful insertion in the 2nd attempt with more than 100 s or in three attempts, and fourth grade as failed insertion. Regarding the rate of complications, based on the incidence of each complication, we need larger sample size to show the difference in each group but considering overall complications (35%), the mentioned sample size is sufficient to show the possible significant difference. He also mentioned SORT maneuver as an ideal technique for NGT insertion in critically ill patients with COVID-19. As this technique considers anatomical characteristics, it can be an ideal option for health care workers who are familiar with this technique and airway anatomy. Moreover, every physician/nurses should notice the fact that NGT insertion is an aerosol producing technique and every one should consider full protection during its insertion with every technique [2]. So, SORT is an easy to learn technique; however, we should not forget the first rule in medicine: “Do not harm at first”. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Authors’ contributions AM and SS contributed equally to the drafting of manuscript and provided critical revision for important intellectual content. Both authors read and approved the final manuscript. Funding No. Competing interests The authors declare no conflict of interests. ==== Refs References 1. Sanaie S Mirzalou N Shadvar K Golzari SEJ Soleimanpour H Shamekh A Bettampadi D Safiri S Mahmoodpoor A A comparison of nasogastric tube insertion by SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) versus neck flexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial Ann Intensive Care. 2020 10 1 79 10.1186/s13613-020-00696-2 32533354 2. Barazzoni R Bischoff SC Breda J Wickramasinghe K Krznaric Z Nitzan D ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection Clin Nutr 2020 39 6 1631 1638 10.1016/j.clnu.2020.03.022 32305181