Sustained pharyngeal inflation on upper airway effects in children—Flexible bronchoscopy measurement

Abstract

Objective Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose‐closure (PhO2‐NC) can create positive peak inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared the effects of four different SPI durations in the PLS. Methods A prospective study, 20 consecutive children aged between 6 months and 3 years old, scheduled for elective flexible bronchoscopy (FB) suspected positive PLS findings were enrolled. SPI was performed twice in four different durations (0, 1, 3, and 5 s) sequentially in each infant. PIP was measured for each SPI in the pharynx, while simultaneously record images at two locations of the oropharynx and supra‐larynx. Patient demographic details, PIP levels, lumen expansion scores, and images of PLS were measured and analyzed. Results Twenty patients with 40 measurements were collected. The mean (SD) age and weight were 11.6 (9.1) months and 6.8 (2.4) kg, respectively. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3), and 65.5 (18.5) cmH2O at SPI duration of 0, 1, 3, and 5 s, respectively, indicating significant (p<.001) positive correlation. At assigned locations, corresponding PLS images also displayed a significant increase in lumen expansion scores and a number of detected lesions with an increase in SPI duration (p < .004). The mean (SD) procedural time was 5.7 (1.2) min. No study‐related complication was noted. Conclusions FB utilizing PhO2‐NC as SPI of 1–3 s is a simple, less invasive, and valuable ventilation modality. It provides an adequate PIP level to expand the PLS and improve FB performance in children.

Early detection of laryngeal cleft in infants by novel technique of flexible endoscopy with sustained pharyngeal inflation

“…SPI with simultaneous chin-lift help to pneumatically expand the PLS including larynx, hypopharynx, esophageal inlet and upper esophagus. In our prior study 19 of identical setting, the SPI with duration of 0 to 5 seconds could create linear correlated positive pressure levels from 4.1±3.3 to 65.5±18.5 cmH 2 O in PLS. When the nose was open (SPI 0 second), the intra-PLS pressure around 4.1±3.3 cmH 2 O, the surrounding structures were relatively collapse included the posterior glottis space.…”

“…This allows us to perform many bronchoscopic interventions that otherwise cannot be safely performed in infants with severe asphyxia condition. [13][14][15][16][17][18][19] If FE-NIV-SPI is routinely applied in all FE, this review suggest that it may detect more LC at the first laryngeal examination. Although the deeper involved lesions, such as type IV, may still need a RE to confirm, the most commonly types of I, II and III LC defects can be diagnosed reliable with FE-NIV-SPI.…”

“…SPI of 1 to 5 seconds, as required, was applied to gradually inflate and expand spaces of supraglottis and hypopharynx for clear FE inspection. 19 In case of LC, a deep fissure over the posterior larynx could be observed. The size of the defect and its relationship with surrounding structures were measured by manipulating scope tip or using forceps.…”

“…[16][17][18] In this NIV, maneuvers of prolonged nose-closure, 1 to 5 second, can create sustained pharyngeal inflation (SPI) with enough, dynamic and controllable PPV to expand the PLS and allows precise FE assessment. 19 Over the last two decades, we have routinely using this FE-NIV and SPI (FE-NIV-SPI) technique and have successfully detected many LC lesions at their first FE inspection of larynx.…”

Flexible Endoscopy With Non-invasive Ventilation Enables Clinicians to Assess and Manage Infants With Severe Bronchopulmonary Dysplasia

“…“Pharyngeal oxygen with optional nose closure and abdomen compression (PhO 2 –NC–AC)” is a novel model of non-invasive ventilation (NIV), which can provide oxygenated PPV without using an artificial device such as an Ambu bag, face or nasal mask, laryngeal mask airway, ET, or ventilator. Previous studies ( 14 – 19 ) have demonstrated its efficacy in providing adequate oxygenation and ventilation during FE procedures of the AET in pediatric patients, even in a high-risk population. To our knowledge, there is no study that investigated the use of FE with NIV (FE-NIV) support to evaluate infants with sBPD.…”