Oxygen Reserve Index (ORiTM) as an alarm for oxygenation deterioration in pediatric tracheostomaplasty: A case report

Dear Editor, The swivel connector (Figure 1) used in flexible bronchoscopy typically has an opening much wider than the outer diameters of pediatric bronchoscopes. There is, therefore, considerable gas leak during flexible bronchoscopy for neonates and small children, mak‐ ing ventilation difficult or impossible during the procedure. We rec‐ ommend the use of an adaptor, in this case, a biopsy valve (Figure 1) normally used for endoscopy. Using the Olympus (Center Valley, PA) LF‐P flexible bronchoscope (outer diameter insertion tube: 1.8 mm), this biopsy valve starts to have a minute leak at a pressure of 51 cm H2O.