0
Correspondence |

Air-Splinting Maneuver During Flexible Fiber-optic BronchoscopyAir-Splinting Maneuver During Bronchoscopy FREE TO VIEW

Rahul Magazine, MD
Author and Funding Information

From the Department of Pulmonary Medicine, Kasturba Medical College, Manipal University.

Correspondence to: Rahul Magazine, MD, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka-576104, India; e-mail: rahulmagazine@gmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(3):812-813. doi:10.1378/chest.12-0842
Text Size: A A A
Published online

To the Editor:

Flexible fiber-optic bronchoscopy is a well-established procedure and is regularly taught to trainee medical professionals in teaching hospitals. While doing this procedure via the transnasal route, I have noticed that in some patients the soft palate and posterior pharyngeal wall are in contact, and there may be no lumen visible when the scope has reached the junction of the nasopharynx with the oropharynx. This may cause difficulty in orienting and advancing the bronchoscope further ahead, particularly for a beginner.

I have found that making the patient breathe through his or her nose with mouth closed opens up the lumen much more than when the patient is breathing with mouth open. In addition, the operator gets a clear orientation to move the bronchoscope ahead. This maneuver, which I call Magazine’s air-splinting maneuver, has been successful in opening up the lumen in 20 such patients. All the patients were given IV midazolam for sedation and could be aroused to follow the verbal instructions for performing the maneuver. If the level of sedation is deeper, the patient may not be expected to do the same. The head-tilt chin-lift technique alone fails to open the lumen in these patients. However, the combination of both is useful only if there is additional obstruction due to the tongue falling back against the posterior pharyngeal wall. In patients in whom the lumen of the oropharynx is visible, this maneuver opens it up further and, thus, enlarges the field of vision in some cases.

The principle behind the maneuver is simple to understand. Nasal breathing with the mouth closed will force the entire inhaled or exhaled air to flow via the nasopharynx. Hence, air will act like a splint and keep the lumen open. If the patient is asked to breathe deeper and, hence, increase the tidal volume, then, as expected, the splinting action is further enhanced. The pharyngeal splinting effect of CPAP was described by Rothfleisch et al1 and McGrath et al2 to enhance the visualization of the upper airway. The air-splinting maneuver I describe will be of help to bronchoscopists, particularly beginners, who use the transnasal route when performing flexible bronchoscopy.

Rothfleisch R, Davis LL, Kuebel DA, deBoisblanc BP. Facilitation of fiberoptic nasotracheal intubation in a morbidly obese patient by simultaneous use of nasal CPAP. Chest. 1994;106(1):287-288. [PubMed] [CrossRef]
 
McGrath G, Das-Gupta M, Clarke G. Bronchoscopy via continuous positive airway pressure for patients with respiratory failure. Chest. 2001;119(2):670-671. [PubMed] [CrossRef]
 

Figures

Tables

References

Rothfleisch R, Davis LL, Kuebel DA, deBoisblanc BP. Facilitation of fiberoptic nasotracheal intubation in a morbidly obese patient by simultaneous use of nasal CPAP. Chest. 1994;106(1):287-288. [PubMed] [CrossRef]
 
McGrath G, Das-Gupta M, Clarke G. Bronchoscopy via continuous positive airway pressure for patients with respiratory failure. Chest. 2001;119(2):670-671. [PubMed] [CrossRef]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543