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.