RT Journal Article
SR Electronic
T1 Videolaryngoscopy With Noninvasive Ventilation in Subjects With Upper-Airway Obstruction
JF Respiratory Care
FD American Association for Respiratory Care
SP 222
OP 230
DO 10.4187/respcare.04784
VO 62
IS 2
A1 Sayas Catalán, Javier
A1 Jiménez Huerta, Ignacio
A1 Benavides Mañas, Pedro
A1 Luján, Manel
A1 López-Padilla, Daniel
A1 Arias Arias, Eva
A1 Hernández Voth, Ana
A1 Rabec, Claudio
YR 2017
UL http://rc.rcjournal.com/content/62/2/222.abstract
AB BACKGROUND: Noninvasive ventilation (NIV) titration may be difficult when dynamic airway obstruction episodes persist, even with high expiratory positive airway pressure (EPAP). We aimed to determine the usefulness of videolaryngoscopy during NIV for identifying mechanisms and sites of obstruction and for providing a guide for their resolution in difficult-to-titrate subjects.METHODS: When obstructions during NIV were present in the built-in software, EPAP was raised to 12 cm H2O. If obstructions persisted, a polygraphy during NIV was performed; if the events occurred with effort, a videolaryngoscopy with nasal and oronasal masks in awake subjects was performed.RESULTS: In a population of 208 subjects in whom NIV was initiated, 13 were identified as difficult to titrate with persistent obstructions during NIV despite an EPAP of 12 cm H2O. Videolaryngoscopy during NIV was able to identify the mechanism and the site of obstruction in all cases. The obstruction under oronasal mask ventilation was due to soft-palate (velum) collapse in 4 subjects, to epiglottic backward movement in 5 other subjects, and to tongue-base obstruction reducing the retroglossal space in 3 more. Videolaryngoscopy during NIV demonstrated improvement in 9 subjects (69%) upon changing to nasal mask and suggested a possible surgical approach in 2 (15%); in one of these 2 subjects, a successful uvulopalatopharyngoplasty was performed.CONCLUSIONS: The use of videolaryngoscopy during NIV in difficult-to-titrate patients may help to identify the sites and mechanisms of obstruction and in some cases may improve quality of ventilation.