We thank the readers for their queries - their concern is justifiable. Quality improvement (QI) projects are being widely used to improve quality of care in patient management. In fact several government-supported QI projects are underway eg, LaQshya program. These projects do not need any ethical approval as they intend to implement already established evidence-based recommendations in clinical practice. We also implemented evidence-based practices and recommen-dations modified to our needs and available resources in this project. As long as no new intervention of questionable efficacy is introduced, QI projects do not need any ethical approval. Taking ethical approval in such cases would just hamper rapid progress in delivering quality care.

We did not calculate sample size for the study. The targets in QI projects are usually not based on sample size. There are many ways to set targets eg, benchmarks, percentiles, best achieved elsewhere etc. In our project, there is no benchmark or we can say that there should be theoretically zero extubation failures. Setting zero extubation failures as target would be unrealistic. So, a realistic target is set depending on our current performance and feasibility.

We did not find any discrepancy in Fig. 2 and table I of the article.