A multiwavelength study of the massive star forming region IRAS 06055+2039 (RAFGL 5179)

We present a multiwavelength study of the massive star forming region associated with IRAS 06055+2039 which reveals an interesting scenario of this complex where regions are at different stages of evolution of star formation. Narrow band near-infrared (NIR) observations were carried out with UKIRT-UFTI in molecular hydrogen and Br$\gamma$ lines to trace the shocked and ionized gases respectively. We have used 2MASS $J H K_{s}$ data to study the nature of the embedded cluster associated with IRAS 06055+2039. We obtain a power-law slope of 0.43$\pm$0.09 for the $K_{s}$-band Luminosity Function (KLF) which is in good agreement with other young embedded clusters. We estimate an age of 2 -- 3 Myr for this cluster. The radio emission from the ionized gas has been mapped at 610 and 1280 MHz using the Giant Metrewave Radio Telescope (GMRT), India. Apart from the diffuse emission, the high resolution 1280 MHz map also shows the presence of several discrete sources which possibly represent high density clumps. The morphology of shocked molecular hydrogen forms an arc towards the N-E of the central IRAS point source and envelopes the radio emission. Submillimetre emission using JCMT-SCUBA show the presence of a dense cloud core which is probably at an earlier evolutionary stage compared to the ionized region with shocked molecular gas lying in between the two. Emission from warm dust and the Unidentified Infrared Bands (UIBs) have been estimated using the mid-infrared (8 -- 21 $\mu$m) data from the MSX survey. From the submillimetre emission at 450 and 850 $\mu$m the total mass of the cloud is estimated to be $\sim$ 7000 -- 9000 $\rm M_{\odot}$.Comment: Accepted for publication in A &

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. RESULTS: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). CONCLUSIONS: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

ATLASGAL-selected massive clumps in the inner Galaxy. VI. Kinetic temperature and spatial density measured with formaldehyde

Context: Formaldehyde (H2CO) is a reliable tracer to accurately measure the physical parameters of dense gas in star-forming regions. Aim: We aim to determine directly the kinetic temperature and spatial density with formaldehyde for the ~100 brightest ATLASGAL-selected clumps (the TOP100 sample) at 870 ?m representing various evolutionary stages of high-mass star formation. Methods: Ten transitions (J = 3–2 and 4–3) of ortho- and para-H2CO near 211, 218, 225, and 291 GHz were observed with the Atacama Pathfinder EXperiment (APEX) 12 m telescope. Results: Using non-LTE models with RADEX, we derived the gas kinetic temperature and spatial density with the measured para-H2CO 321–220/303–202, 422–321/404–303, and 404–303/303–202 ratios. The gas kinetic temperatures derived from the para-H2CO 321–220/303–202 and 422–321/404–303 line ratios are high, ranging from 43 to >300 K with an unweighted average of 91 ± 4 K. Deduced Tkin values from the J = 3–2 and 4–3 transitions are similar. Spatial densities of the gas derived from the para-H2CO 404–303/303–202 line ratios yield 0.6–8.3 × 106 cm?3 with an unweighted average of 1.5 (±0.1) × 106 cm?3. A comparison of kinetic temperatures derived from para-H2CO, NH3, and dust emission indicates that para-H2CO traces a distinctly higher temperature than the NH3 (2, 2)/(1, 1) transitions and the dust, tracing heated gas more directly associated with the star formation process. The H2CO line widths are found to be correlated with bolometric luminosity and increase with the evolutionary stage of the clumps, which suggests that higher luminosities tend to be associated with a more turbulent molecular medium. It seems that the spatial densities measured with H2CO do not vary significantly with the evolutionary stage of the clumps. However, averaged gas kinetic temperatures derived from H2CO increase with time through the evolution of the clumps. The high temperature of the gas traced by H2CO may be mainly caused by radiation from embedded young massive stars and the interaction of outflows with the ambient medium. For Lbol/Mclump ? 10 L?/M?, we find a rough correlation between gas kinetic temperature and this ratio, which is indicative of the evolutionary stage of the individual clumps. The strong relationship between H2CO line luminosities and clump masses is apparently linear during the late evolutionary stages of the clumps, indicating that LH_2CO does reliably trace the mass of warm dense molecular gas. In our massive clumps H2CO line luminosities are approximately linearly correlated with bolometric luminosities over about four orders of magnitude in Lbol, which suggests that the mass of dense molecular gas traced by the H2CO line luminosity is well correlated with star formation

Corrigendum to ‘Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study’ (Br J Anaesth 2021; 126: 1173–81) (British Journal of Anaesthesia (2021) 126(6) (1173–1181), (S0007091221001161), (10.1016/j.bja.2021.02.021))

The authors regret that errors were present in the above article. On page 1174, in the second paragraph of the Statistical methods section, the second sentence should read as follows: The incidence of difficult intubation was determined including those whose tracheas were already intubated and is reported as a percentage with a 95% exact binomial CI. On page 1175, in the third paragraph of the Statistical methods section ‘mean standardised difference (MSD)’ should read ‘standardised mean difference (SMD)’ The authors would like to apologise for any inconvenience caused