Background
Successful management of severe bronchopulmonary dysplasia (sBPD) requires a multidisciplinary approach to optimize respiratory care, proper pharmacotherapy, adequate nutrition, offer appropriate interventions and search for comorbidities. Much importance is placed on identifying the pathologies in each infant with sBPD and accordingly adjust their individualized managing strategies in an evidence-based fashion. Flexible endoscopy (FE) is a well-established and safe tool for direct visual inspection and evaluation of dynamic aero-esophageal (AE) anomalies for patients in the endoscopy room or intensive care unit (ICU) setting.1-3 Infants with sBPD typically have prolonged hospitalization course requiring numerous invasive managing in the AE tract which include invasive positive pressure ventilation (PPV), multiple attempts of intubation and extubation of endotracheal tube (ET) and feeding tube, noninvasive ventilation (NIV) and airway suctioning during hospitalization.4,5 As result, they are vulnerable and risky for iatrogenic AE lesions such as subglottic stenosis, tracheomalacia (TM), bronchomalacia (BM)6-8and gastroesophageal reflux disease (GERD).9-11Studies reported that only less than 5% of patients with BPD had normal airway evaluations.12 Thus, it is important to perform a detailed FE of AE tract so that pathologies can be fully identified. However, the existed AE anomalies and associated cardiopulmonary dysfunction remain challenging for performing the invasive FE procedures and consequent FE-related interventions.
“Pharyngeal oxygen with optional nose-closure and abdomen-compression (PhO2-NC-AC)” is a novel model of NIV with advantages of providing PPV without using artificial device such as Ambu-bag, face or nasal mask, laryngeal mask airway, ET or mechanical ventilator. Previous studies have demonstrated its efficacy in providing adequate oxygenation and ventilation during FE assessment of entire AE tract in pediatric patients with risk of hypoxemia or even respiratory failure.13-17 To our knowledge, there is no study dealing the modality of FE with this NIV (FE-NIV) support to evaluate infants with sBPD.
The primary objectives of this study were 1) to describe the diagnostic findings of FE-NIV for assessment of AE lumens and 2) the resultant changes in clinical management of infants with sBPD.