NIV-SPI
A small nasopharyngeal (suction) catheter (8 Fr.) was inserted via one (right) nostril to a length of 0.5 cm less than the measured distance from nose tip to ipsilateral tragus which ensured the tip positioned in the oropharynx. Then, a heated humidified continuous oxygen flow was provided through the catheter at rate of 1.0 L/kg/min. So that oxygen could fill the entire upper airway space (Figure 1), which bearing similarities to “high flow nasal cannula”. Endoscopist’s index finger of right hand hooked under the neonate’s chin while both thumb and mid-finger placed around ala nasi in a pinching position as well as holding the endoscope at nose. Then, following maneuvers were executed optionally to deliver PPV:
(1) Inspiration phase was accomplished by nose(mouth)-closure with pinching thumb, index and mid-finger of right hand. Cricoid pressure might also be applied concurrently with ipsilateral little finger. While the SPI with duration of 2 to 5 seconds might also provide. (2) Expiration phase was started passively with the release of the nose-closure, which could be further facilitated with simultaneous mild compression of umbilical region and release of cricoid-pressure. Above steps were performed optionally at the rate of 5–10 cycles per minute.