Bubble continuous positive airway pressure (B-CPAP) applies small-amplitude, high-frequency oscillations in airway pressure (⌬P aw ) that may improve gas exchange in infants with respiratory disease. We developed a device, high-amplitude B-CPAP (HAB-CPAP), which provides greater ⌬P aw than B-CPAP provides. We studied the effects of different operational parameters on ⌬P aw and volumes of gas delivered to a mechanical infant lung model. In vivo studies tested the hypothesis that HAB-CPAP provides noninvasive respiratory support greater than that provided by B-CPAP. Lavaged juvenile rabbits were stabilized on ventilator nasal CPAP. The animals were then supported at the same mean airway pressure, bias flow, and fraction of inspired oxygen (F i O 2 ) required for stabilization, whereas the bubbler angle was varied in a randomized crossover design at exit angles, relative to vertical, of 0 (HAB-CPAP0; equivalent to conventional B-CPAP), 90 (HAB-CPAP90), and 135°(HAB-CPAP135). Arterial blood gases and pressure-rate product (PRP) were measured after 15 min at each bubbler angle. PaO 2 levels were higher (p Ͻ 0.007) with HAB-CPAP135 than with conventional B-CPAP. PaCO 2 levels did not differ (p ϭ 0.073) among the three bubbler configurations. PRP with HAB-CPAP135 were half of the PRP with HAB-CPAP0 or HAB-CPAP90 (p ϭ 0.001). These results indicate that HAB-CPAP135 provides greater respiratory support than conventional B-CPAP does. (Pediatr Res 67: 624-629, 2010) B ubble-nasal continuous positive airway pressure (BnCPAP) is a form of noninvasive respiratory support that is used frequently as a primary strategy for supporting spontaneously breathing preterm infants at risk of developing respiratory distress syndrome. Compared with intubation and mechanical ventilation, the use of B-CPAP has been associated with lower indicators of acute lung injury (1) and bronchopulmonary dysplasia (2).Recent studies suggest that the bubbling of gas exiting the B-nCPAP circuit at the water seal creates oscillations in airway pressure (⌬P aw ), having broadband high frequencies (3), which may promote airway patency and enhance lung volume and gas exchange in preterm lambs (4). However, a study of 261 consecutively born premature infants revealed that 24% of infants born weighing Ͻ1250 g and 50% of infants weighing Ͻ750 g failed B-nCPAP and required endotracheal intubation and mechanical ventilation (5). In an effort to diminish the potentially deleterious effects of invasive mechanical ventilation (6), we designed a novel device, highamplitude B-CPAP (HAB-CPAP), which, through alterations in angle of gas entry at the water seal, may enhance respiratory efficiency and improve oxygenation when compared with conventional B-nCPAP.In this report, we describe a device that provides ⌬P aw higher in amplitude than B-CPAP. Studies were conducted to determine the effects of bubbler angle and bias flow on ⌬P aw and the amplitude of oscillations in volume (⌬V) delivered to a mechanical model of an infant lung. In addition, studies were con...

Although SCC with and without IP association are considered different diseases, their demographics and outcomes seem similar. Nodal metastasis was noted to be higher in the SCC cohort, which may indicate different tumor biology. Further study is warranted.

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Objectives Osteoradionecrosis (ORN) of the skull base and craniovertebral junction is a challenging complication of radiation therapy (RT). Severe cases often require surgical intervention through a multi‐modal approach. With the evolution in endoscopic surgery and advances in skull base reconstruction, there is an increasing role for microvascular free tissue transfer (MFTT). We describe an endoscopic‐assisted approach for the management of ORN of the skull base using fascia lata for MFTT. Study Design Retrospective case series. Methods Between 2017 and 2021, a review of all cases in which fascia lata MFTT was utilized for skull base ORN was performed. Patient demographics, preoperative characteristics, and postoperative outcomes with long‐term follow‐up were reviewed. Results Five patients were identified. Mean duration to onset of ORN was 17 months following RT. A trial of antibiotics, hyperbaric oxygen (HBO), and/or limited debridement was attempted without success. Refractory pain and progressive osteomyelitis were unifying symptoms. All patients underwent endoscopic debridement of the affected region of ORN prior to MFTT. Vascularized fascia lata was inset through a combined endonasal and transoral corridor. There was improvement in chronic pain in the postop setting with no patients requiring continued antibiotics or HBO therapy. Mean post‐op follow‐up was 23 months. Conclusions With continued evolution in endoscopic, minimally invasive approaches, there is an expanding indication for early surgical management in refractory ORN. Fascia lata MFTT is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. Level of Evidence 4 Laryngoscope, 133:562–568, 2023