FE-NIV preparation
FE patients followed a standard preparation. Procedural sedation of
intravenous midazolam 0.1-0.2mg/kg, ketamine 1-2mg/kg and atropine
0.01mg/kg was given to keep patient motionless yet still maintain
spontaneous breathing. Topical anesthesia of 2% lidocaine solution, 1.0
ml/kg, was applied via syringe catheter into patient’s nostrils and
trachea. A continuous oxygen flow (1.0 L/Kg/min, maximal 10.0 L/min)
delivered through a small nasopharyngeal catheter as the “pharyngeal
oxygen, PhO2”. PhO2-NC-AC technique was
routinely used to ensure adequate oxygenation and ventilation during the
entirety of FE procedure. Vital signs including heart rate, respiration,
oxygen saturation and blood pressure were continuously monitored.
FE performed with a short working-length (30 cm) flexible endoscope,
outer diameter 2.6 mm or 3.2 mm (Olympus, ENF-V2 or ENF-V3), without
inner cannel. Flexible bronchoscope was introduced into the nasal tract
and advanced into the supraglottic region. With chin lift maneuver, the
entire larynx including the epiglottis, arytenoids, vocal cords and
hypopharynx could be visualized. (Figure 1a) During nose-open phase, the
posterior laryngeal commission and hypopharyngeal wall may appose each
other and resulted a collapsed esophageal inlet.