NIV support
Infant’s original respiratory devices including nasal cannula, nasal prongs, artificial airway and mechanical ventilator, if presented, were replaced with the following NIV support. The tracheostomy stoma, if presented, was sealed closely sealed with tape.
NIV support using PhO2-NC-AC approach13,15 throughout the whole FE course which was described below. A continuous, warmed and humidified pure oxygen flow (1.0 L/kg/min) was delivered through a nasopharyngeal catheter (preferably right nostril) to fill the upper airway cavity. In this NIV, sustained pharyngeal inflation (SPI) with duration of nose-closure (NC) of 0 to 3 seconds was optionally applied. With infant’s mouth closed by hooking endoscopist’s right index finger at submental bone, following maneuvers were performed to deliver the PPV: (1) Inspiration phase was accomplished by NC with thumb and mid-finger (Figure 1a). Cricoid pressure might also be applied concurrently with endoscopist’s ipsilateral little finger. SPI was performed for 0 to 3 seconds. (2) Expiration phase (Figure 1b) was started passively with the release of NC and cricoid pressure, which could be facilitated with simultaneous abdomen-compression (AC) over umbilical region. Above steps were performed optionally at a rate of 5–10 cycles per minute. Endoscopist could simultaneously doing both the FE and NC (release) maneuver, while an assistant (if present) might give the AC (release).