Fiberoptic Bronchoscopy in Respiratory Failure

To the Editor.—  The use of the Rovenstine 90° elbow connector by Dr. Tahir for maintaining ventilation during fiberoptic bronchoscopy has improved the safety of this procedure in patients requiring mechanical ventilation (220:725, 1972). We have found this technique invaluable in patients with extreme respiratory failure who could not do without the ventilator for more than very brief periods that are inadequate for bronchoscopy.Unfortunately, the sharp-toothed end of the suction channel of the connector proved to be harmful to the plastic coating of the bronchoscope. To avoid this problem, we smoothed out the toothed end of the suction channel and fitted a 3-cm long, hard, plastic sleeve into it. An O-ring, into which the bronchoscope fits tightly, was incorporated into the proximal end of the sleeve to prevent leakage of air during positive pressure ventilation (Figure). The bronchoscope was also coated with a thin layer of xylocaine jelly for