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

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial 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. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Szacowanie ryzyka powstania szkody górniczej w obszarze hipotetycznego oddziaływania współbieżnych procesów zaburzeń górotworu

The aim of this work is the estimation of the risk of mining damage occurrence, based on uncertain information regarding the impact of the concurrent processes of deformation and vibration. This problem concerns the experimental and theoretical description of the so-called critical phenomena occurring during the reaction mining area ↔ building object. Post-mining deformations of the rock mass medium and paraseismic vibrations can appear at a considerable distance from the sub-area of the mining operation – hence, the determination of the measures of their impacts is usually somewhat subjective, while the estimation of the mining damage based on deterministic methods is often insufficient. It is difficult to show the correlation between the local maximum of the impact of the velocity vector amplitude and the damage to the building – especially if the measures of interaction are not additive. The parameters of these impacts, as registered by measurements, form finite sets with a highly random character. Formally, it is adequate to the mapping from the probability space to the power set. For the purposes of the present study, the Dempster – Shafer model was used, where space is characterised by subadditive and superadditive measures. Regarding the application layer, the conclusions from the expert evaluations are assumed to be the values of random variables. The model was defined, and the risk of damage occurrence was estimated.Celem pracy jest szacowanie ryzyka powstania szkody górniczej, poprzez niepewne informacje dotyczące oddziaływania współbieżnych procesów deformacyjnych i drgań. Problem dotyczy doświadczalnego i teoretycznego opisu tak zwanych zjawisk krytycznych, zachodzących podczas reakcji teren górniczy ↔ obiekt budowlany. Pogórnicze deformacje ośrodka oraz drgania parasejsmiczne ujawniają się również w znacznej odległości od podobszaru eksploatacji – stąd też wyznaczenie miar tych oddziaływań z reguły jest nieco subiektywne a szacowanie szkody górniczej metodami deterministycznymi często jest niewystarczające. Trudno jest wykazać, że istnieje skorelowanie pomiędzy lokalnym maksimum oddziaływania amplitudy wektora prędkości a szkodą w obiekcie – zwłaszcza, jeśli miary oddziaływania nie są addytywne. Zarejestrowane w wyniku pomiaru parametry tych oddziaływań to zbiory skończone o charakterze silnie losowym. Formalnie jest to odwzorowanie z przestrzeni probabilistycznej do zbioru potęgowego. Dla celów niniejszej pracy wykorzystany został model Dempstera – Shafera, gdzie przestrzeń charakteryzują miary pod lub nadaddytywne. W warstwie aplikacyjnej skorzystano z konkluzji ocen eksperckich przyjmując je, jako wartości zmiennej losowej. Zdefiniowano model i oszacowano ryzyko wystąpienia szkody

Analizy dotyczące procesów typu parabolicznego dla szacowania stabilności odwzorowań przemieszczeń terenu górniczego w systemie INGEO

The article features deliberations concerning the analysis of the following in the homomorphism of processes: deformations corresponding to the medium (rock mass) vibrations which generate physical threats in the subarea of topological transformations. Here, the basic issue is deformation mapping applied to model the dislocation processes related to the paraseismic process. Time dependencies are characterized by structure and dynamics of the processes. The damage of the part of the rock mass near the exploited deposit causes deformations and, most frequently, topological transformation of successive layers. Quite often rock bursts are generated, which is related mainly to the exceeded boundary states of the medium. Here it is very important to have measuring information about the medium transformations. In addition, it is necessary to define parameters and measures that characterize the anisotropy of the rock mass structures. The research within the INGEO project was focused on solutions based on the adaptation of the parabolic differential description supported by monitoring a concrete physical dislocation process. The mapping state of the process trajectory was distinguished in the deformation space by means of mathematical algorithms. Numerical modelling of deformation fields was supported by GPS sensors (innovative direct monitoring), on-line GNSS technology, and compaction sensors with a view to measuring complex dislocation fields. This solution is a new technology. A parametrically optimized model adequately illustrates a standard (measurement results) layout of vertical dislocations.W pracy przedstawiono rozważania dotyczące analizy w homomorfizmie procesów: deformacji z odniesieniem do drgań ośrodka (górotworu) generujących zagrożenia fizykalne podobszaru przekształceń topologicznych. Podstawowe są tu odwzorowania deformacyjne, służące do modelowania procesów przemieszczeń komunikujących się z procesem para-sejsmicznym. Cechami zależności czasowych są: struktura i dynamika procesów. Proces zniszczenia części warstw górotworu w otoczeniu eksploatacji złoża, wywołuje deformacje i najczęściej przekształcenia topologiczne kolejnych warstw, często generuje również wstrząsy górnicze - co związane jest głównie z przekroczeniem stanów granicznych ośrodka. Istotna jest tu informacja pomiarowa odnośnie do przekształceń ośrodka oraz zdefiniowania parametrów i miar charakteryzujących anizotropię jego struktur. Prace badawcze w projekcie INGEO dotyczyły m.in. rozwiązań bazujących na przystosowaniu opisu różniczkowego parabolicznego, wspomaganego monitorowaniem konkretnego fizykalnego procesu przemieszczeń. Wyróżniono w przestrzeni deformacji stan odwzorowania trajektorii procesu poprzez matematyczne algorytmy. Numeryczne modelowanie pól deformacyjnych wspomagane było, zastosowaniem sensorów GPS - innowacyjny bezpośredni monitoring - technologia GNSS on-line oraz czujników kompakcji do pomiarów złożonych pól przemieszczeń, co stanowi nową technologię. Zoptymalizowany – w zakresie parametrów- model trafnie odtwarza wzorcowy (wyniki pomiaru) rozkład przemieszczeń pionowych

Flow cytometry as a modern tool in evaluation the activity of microorganisms degrading polycyclic aromatic hydrocarbons (PAHs) in bioremediation process

Zanieczyszczenie środowiska związkami organicznymi można zredukować m.in. poprzez metody bioremediacyjne z wykorzystaniem np. bioaugmentacji lub biosurfaktantów. Celem badań jest określenie aktywności metabolicznej konsorcjów mikrobiologicznych dodawanych na zasadzie bioaugmentacji oraz mikroorganizmów autochtonicznych w obecności wielopierścieniowych węglowodorów aromatycznych (WWA) i biosurfaktantów (ramnolipidów) w środowisku glebowym. Aktywność metaboliczna została wyznaczona dzięki zastosowaniu cytometrii przepływowej. Uzyskane wyniki wskazują zarówno na konkurencję pomiędzy mikroorganizmami wprowadzonymi dodatkowo a mikroorganizmami autochtonicznymi już po trzech miesiącach trwania eksperymentu, jak również na zdominowanie układu przez dodatkowo wprowadzone mikroorganizmy po upływie sześciu miesięcy. Równocześnie wyniki nie wskazują na jakikolwiek wpływ dodanych ramnolipidów na wartość %Q2.Environmental pollution by organic compounds can be reduced by the use of bioremediation methods e.g. bioaugmentation enhanced by the addition of biosurfactants. The aim of this study was to determine the metabolic activity of both microbial consortia added into system and autochthonous microorganisms in the presence of polycyclic aromatic hydrocarbons (PAHs) and biosurfactants (rhamnolipids) in the soil system. Metabolic activity was determined using flow cytometry. The results indicate both the competition between additional and autochthonous microorganisms after three months, as well as the dominance of additional microorganisms over native microorganisms after six months of start of the experiment. Moreover, the results do not indicate any effect of rhamnolipids on the value of %Q2