"Car il savait.., que le bacille de la peste ne meurt ni ne disparaît jamais,.., et
que, peut-être, le jour viendrait où, pour le malheur et l'enseignement des hommes,
peste réveillerait ses rats et les enverrait mourir dans une cité heureuse." (Albert
Camus "LA PESTE", 1947)
"He knew...that the plague bacillus never dies or disappears for good; that it can
lie dormant for years and years...; and that perhaps the day would come when, for
the bane and the enlightening of men, it would rouse up its rats again and send them
forth to die in a happy city." ("THE PLAGUE", translation by Stuart Gilbert).
This Special Issue of the British Journal of Anaesthesia on ‘Respiration and the Airway’
follows on from WAMM 2019, the second World Airway Management Meeting, held in the
beautiful Beurs van Berlage building in Amsterdam, on 13-16 November 2019. Hosted
by the Difficult Airway Society (DAS), Society of Airway Management (SAM), and European
Airway Management Society (EAMS), and supported by 30 international airway groups,
the conference presented a world-class programme of internationally renowned experts
in the field of airway management. The WAMM 2019 attracted 1,804 delegates from 70
countries, and included 52 lectures, multiple workshops and 523 presented abstracts,
some of which are collected in this Special Issue.
1
,
2
The success of the meeting led to a call for papers in the Autumn of 2019. We received
many drafts from around the world, which underwent our rigorous peer review process,
resulting in the collection of X [update at proof stage] articles published here.
Since the BJA is the affiliated journal of the WAMM, this issue also contains the
top 30 abstracts selected by a panel of experts at WAMM 2019. Together, these articles
have been made freely available to all readers immediately upon publication, and they
provide essential information for the safe practice of respiratory and airway management.
The BJA recognizes that current strategies for airway management are still not ideal
in many areas,3, 4, 5 and has long supported the activities of societies dedicated
to airway management.
6
This includes the publication of several influential studies and guidelines on airway
management.7, 8, 9 We also launched our first Special Issue on Airway Management in
2016,
10
which followed the first WAMM held in Dublin in 2015. This issue reviewed current
problems associated with airway management and provided evidence-based preventative
and treatment methods to reduce life-threatening complications associated with airway
management.
Since publication of the first Special issue on Airway Management,
10
there has been considerable development in equipment, strategies, and training methods
of airway management.11, 12, 13, 14 There has also been increasing attention paid
to developing effective airway and respiratory management approaches outside the operating
room.
5
,
15, 16, 17, 18, 19 A notable project addressing this area is the Project for Universal
Management of Airways (PUMA; https://www.universalairway.org), which aims to produce
a set of principles that reflect a consensus of existing published airway guidelines
that can be applied to all episodes of airway care, across boundaries of geography,
clinical discipline and context. The concept, methodology, and the progress of this
project were presented at WAMM 2019. This project could only be achieved through international
collaboration of experts on airway management and interdisciplinary collaboration.
This Special Issue contains new findings regarding effective airway management during
anaesthesia and in critically ill patients, including technical strategies for the
‘cannot intubate, cannot oxygenate’ scenario.20, 21, 22, 23, 24, 25, 26 Attention
to the role of cognitive psychology in improving management and training of the cannot
intubate cannot oxygenate (CICO) scenario is provided.
2
Additional articles address respiratory management, in particular as it relates to
postoperative pulmonary complications and drug-induced respiratory depression.27,
28, 29
In the course of preparing this Special Issue, the world was overcome with an enormous
challenge: the COVID-19 global pandemic. Toward the end of 2019, China alerted the
World Health Organization (WHO) to several cases of an unusual pneumonia in Wuhan,
Hubei province, possibly caused by an unknown virus. At the beginning of 2020, a new
virus (initially named 2019-nCoV, now changed to SARS-CoV-2) was identified as belonging
to the coronavirus family, which includes Severe Acute Respiratory Syndrome coronavirus
(SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The virus
has spread globally, and in March, the WHO declared the coronavirus outbreak a global
pandemic. A month after the outbreak in Wuhan, the death toll in China surpassed that
of the SARS epidemic in 2002-3, and the death toll continues to rise. It is now clear
that patients with this new virus (coronavirus infectious disease-2019, or COVID-19)
frequently require advanced respiratory support, including noninvasive and invasive
ventilation. This novel coronavirus is highly contagious, putting people who perform
airway management and other aerosol and droplet generating procedures at a high risk
of infection without proper protection. Thus, airway experts are in the midst of one
of the most challenging scenarios for difficult airway and respiratory management.
As a consequence of the WAMM meeting in 2019 and the collaborations that were established,
anaesthetists with a particular interest in airway management from across the globe
have been working together. This has led to a much greater understanding of the complexities
of airway management and ventilation in the COVID-19 patients. Many groups are now
working together to establish best practice guidelines and research projects to improve
the management of this challenging group of patients. In addition, the concept of
an Airway Lead network (https://www.niaa.org.uk/NAPAirwayLeads#pt)
30
is being adapted worldwide. The benefits of this network have been recognized across
the UK with almost 97% of National Health Service (NHS) hospitals now having airway
leads. Ireland and New Zealand have also established the network whilst they are in
development in Australia, Canada and the US. The specific function of airway leads
will vary slightly depending on the locale, but involves co-ordination of personnel,
training and equipment with respect to airway management across the institution.
In response to the COVID-19 crisis, the BJA has been facilitating rapid dissemination
of relevant information through a new monthly feature in the Journal known as COVID-19
and the anaesthetist: a special series. A special collection has also been created
on the BJA website (www.BJAnaesthesia.com) to make all publications on the topic appearing
in the Journal easily accessible, in an effort to disseminate rapidly such knowledge
to our international audience. This includes our rapidly growing body of articles
related to COVID-19 involving patient care, research, opinion, and practical experience.
Articles undergo expert peer review and rapid publication though our Advance Access
feature in preprint form. As a result of this timing, this Special Issue includes
several reports related to topics such as infection prevention during airway and respiratory
management,31, 32, 33, 34 and effective oxygenation methods in patients with COVID-19.
35
,
36
A review article by Odo and colleagues
37
succinctly summarizes how SARS-CoV-2 has spread globally, relevant personal protective
equipment (PPE) policies and the risk of transmission by and to medical staff. A report
of the extensive early experience with airway management carried out in Wuhan is presented,
together with consensus recommendations developed by a panel of international experts
on airway management.
38
This Special Issue of the BJA on Respiration and the Airway provides critical practical
information for the practice of anaesthesia and critical care, which has special significance
in the era of COVID-19. A collection of high-quality articles involving international
collaborations in the areas of airway and respiratory management summarizes the state
of the art, and includes a number of late-breaking publications focusing on the COVID-19
global pandemic. The BJA continues to welcome submissions in the areas of airway management
and respiration, which are featured in a regular section of the Journal as well as
special issues on the topic,
10
including this one. We are fully committed to serving the science and practice of
airway and respiratory management for the benefit our international audience and our
patients. The critical importance of this role in advocating for the submission and
dissemination of high-quality research and clinical guidance in critical care, respiration
and airway management has been highlighted by the current global pandemic. Our commitment
to supporting the critical role that anaesthetists play in the international response
to this and other acute respiratory syndromes is on full display here. It is our sincere
hope that the information included in this Special Issue will benefit our readers
and their patients.
Authors’ contributions
All authors wrote, edited, and approved the final version.
Declaration of interest
TA is co-editor of Special Issue on Airway Management, and editor of the British Journal
of Anaesthesia, Journal of Anesthesia, and JA Clinical Reports.
EPO is co-editor of Special Issue on Airway Management, and a chairperson of the World
Airway Management Meeting 2019.
HCH is editor-in-chief of the British Journal of Anaesthesia.