FE-NIV-SPI assess AET
During FE-NIV assessment, SPI was optionally done by right hand of operator (Figure 1b) with index finger hooked patient’s chin to pull and close patient’s mouth, thumb and mid-finger pinch-closed patient’s nose. 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. The scope was then advanced into the tracheobronchial and the esophageal lumens for further evaluation. Types of LC were based on the Benjamin and Inglis classification.20 SPI maneuver with duration of 3 to 5 seconds could be repeated as necessary. Between each SPI, patient was allowed spontaneous breaths or supported with NIV for at least 10 seconds. The time of making a complete diagnosis, from insertion of endoscope to final confirmation of the LC type, was captured from the video recording.
After completion of FE procedure, abdomen compressions and gastric suctions were routinely performed to eliminate air distention. A post-procedural chest radiography was routinely checked for possible complications of air leak or damages.