Seminars in Pediatric Surgery 30 (2021) 151051

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Seminars in Pediatric Surgery

journal homepage: www.elsevier.com/locate/sempedsurg

Working as a team in airway surgery: History, present and

perspectives
Michele Torre∗, Roberto D’Agostino, Ivana Fiz, Oliviero Sacco, Pietro Salvati,
Annalisa Gallizia, Francesca Rizzo, Mirta Della Rocca, Serena Arrigo, Antonella Palmieri,
Nicola Stagnaro, Italo Borini, Francesco Santoro, Halkwat Nuri, Giuseppe Pomé,
Maurizio Marasini, Vittorio Guerriero, Luca Pio, Federica Lena, Elisabetta Lampugnani,
Franco Puncuh, Silvia Buratti, Stefano Pezzato, Andrea Wolfler, Annalisa Costa,
Monica Faggiolo, Daniela Tronconi, Maria Annunziata Pinna, Daniela Cordeglio,
Armanda Ferullo, Girolamo Mattioli, Andrea Moscatelli, Annalisa Oneto, Claudia Barbieri,
Marzia Musso
Airway Team of IRCCS Giannina Gaslini, Genova, Italy

a r t i c l e i n f o a b s t r a c t

Keywords: Teamwork is one of the most important trend in modern medicine. Airway team were created in many
Tracheal team places to respond in a multidisciplinary and coordinated way to challenging clinical problems which were
Airway surgery
beyond the possibility of an individual management. In this chapter, we illustrate the historical steps
Aerodigestive team
leading to the development of an airway team in a pediatric referral hospital, describe the present team-
Tracheal surgery
Tracheal stenosis work activity defining the key points for the creation of a team and discussing different organization
models; finally we delineate possible future directions for the airway teams in the globalized world.
© 2021 Elsevier Inc. All rights reserved.

Introduction ical competences are encompassed from multiple specialists coop-

Modern medicine is a teamwork activity. If in the past cen-
tury the role of a single professional was determinant for the fi-
nal outcome, the present era successes are considered function of
a well organized multidisciplinary activity more than of individ-
ual abilities. In many fields of medicine and surgery, including air-
way surgery, this cultural and behavioral change became more ev-
ident.1 , 2 With the increase of possibilities of successful treatments
given by the modern techniques and technologies based in ultra-
specialized medicine and surgery, the need of relying on some-
one else’s knowledge and skills is nowadays a necessity more than
it was 10 or 20 years ago. Taking as example pediatric airway
surgery, the competences and skills required are so wide that no
individual surgeon is usually capable of developing them entirely
by himself.
The know-it-all surgeon does not exist anymore. Moreover, the
advantages of a multidisciplinary teamwork are several: more clin-
∗
Corresponding author at: Pediatric Thoracic and Airway Surgery Unit, IRCCS Gi-
annina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
E-mail address: micheletorre@gaslini.org (M. Torre).
erating on a single patient, integration of different brains and skills
can exponentially increase the abilities and shorten the learning
curve of a single professional, shared decisions can be easier to be
taken and defend a single physician, especially in challenging cases
and at risk of legal considerations. In this manuscript, taking as an
example the process that led to the creation of an airway team in
a pediatric Institution, we will present the historical background of
the hospital before the process, define the key points for the cre-
ation of the airway team, present practical examples of its func-
tion, discuss advantages and critical points, and finally we will try
to delineate the future directions.
Historical background
In many pediatric Hospital and Institutions, until the end of the
past century, the possibility of management of airway cases was
very limited. We describe the local situation of one of the largest
pediatric hospital in Italy, that can be paradigmatic for many other
Institutions in different parts of the world at those times.
At the end of the last century, in our Institution (Giannina
Gaslini Children Hospital, Genoa, Italy) the diagnosis of an airway
anomaly was usually suspected by the anesthesiologist or inten-

https://doi.org/10.1016/j.sempedsurg.2021.151051
1055-8586/© 2021 Elsevier Inc. All rights reserved.
M. Torre, R. D’Agostino, I. Fiz et al.
sivist based on his/her clinical experience and on patient symp-
toms. In other occasions, the suspicion of an airway stenosis was
raised by a difficult intubation or tube progression. In either cases,
to perform a precise endoscopic diagnosis was usually not possi-
ble. In most cases, the direct laryngoscopy by the anesthesiologist
was the only diagnostic tool available in the operation room. Flex-
ible endoscopy was very occasionally performed and usually with
the patient awake, making the vision below vocal cords almost im-
possible. CT scan or other radiological studies were used, in some
cases inappropriately, in an attempt to have an idea of the airway
anatomy, but clinical conditions influenced and sometimes heav-
ily hindered the diagnostic workup. Referred patients were usually
not expected, in many cases presented in urgent clinical context,
and their management was extremely stressful and frustrating. In
many cases, tracheostomy was the only way to treat these patients,
even if the precise diagnosis was unknown. With or without tra-
cheotomy, these patients were usually sent abroad, in the few ex-
isting centers where some expertise of such problems was avail-
able. The travel to the referral center, often very far from the hos-
pital, was usually very stressful for the accompanying personnel
and hazardous for the patient.
Later on, endoscopy became available in many centers, includ-
ing ours. However, many different professionals were individually
following their own patients with some airway problems without
any cooperation not even dialogue between different experts or ar-
eas. Flexible endoscopy was performed by otolaryngologists, anes-
thesiologists, pulmonologists, but none of them dared to perform
rigid endoscopy. During this second era of our Institution, the diag-
nosis was more often achieved than it used to be, but the solutions
were almost never available, usually due to the lack of surgical ex-
pertise. For this reason, many of these patients were still sent away
for the treatment.
In our and in many other pediatric hospitals until the year
20 0 0, the competences on airway patient management were still
scattered or overlapping. Moreover, there was no clear leadership.
Otolaryngologists were not always the patient manager because of
lacking of experience in endoscopy and/or laryngotracheal surgery.
The tracheostomies were performed sometimes by them but more
often by general pediatric surgeons or other professionals (cardio-
vascular surgeon, neurosurgeons). It could happen that laryngoma-
lacia patients were managed either by otolaryngologists, neona-
tologists, anesthesiologists, pediatricians or pulmonologists in the
same institution, often with different indications for treatment and
for surgery, and with different follow up. Apart from tracheostomy,
no one was able to perform laryngotracheal endoscopic or open
surgery.
Endoscopic evaluation was slowly becoming the preferred tool
to achieve the diagnosis, giving to radiology a complimentary role
for selected problems. An important clinical and cultural advance-
ment was achieved with the possibility to record images and
videos and discuss them collectively. Before this, just a single pro-
fessional could visualize the problem. With the recording, gather-
ing to see the images and discuss them as a group became nat-
ural. Physicians belonging to different specializations were usu-
ally involved in these meetings. All innovations and trends to-
wards easy communication and social interactions between people
helped this process. Airway was the perfect organ to be considered
as “social”, being a meeting point for different specialists, such as
otolaryngologists, pulmonologists, pediatric surgeons, thoracic sur-
geons, anesthesiologists, intensivists, cardiovascular surgeons, radi-
ologists. This was the germ of the airway teams.
Creation of a team
The first step for the creation of a Pediatric airway team is usu-
ally a strategical decision, made by hospital administrators, when
2
Seminars in Pediatric Surgery 30 (2021) 151051
this specific need is felt. In our Institution, while the need of an
airway team was evident since the first 20 0 0s, it was only in 2007
that this decision was taken, in particular thanks to the vision of
the Chief of Intensive Care and Surgery Department. The first act
was to send the Gaslini’s pediatric surgeon that was most inter-
ested in airway to Cincinnati Airway Team center, directed by prof.
Robin Cotton, for a period of 6 weeks. Another similar period of
time was spent by the same surgeon in the airway training cen-
ter located in Santiago of Chile, called Calvo Mackenna Children’s
Hospital, following the tracheal surgeries of prof. Patricio Varela.
The activities of our team started in 20093 . The difficulty in cre-
ating something new (an airway team) in the specific context of a
pediatric hospital was mainly due to the factors listed in Table 1. In
particular, the lack of specific experience in management of com-
plex airway cases was only the more obvious. The small number
of cases, their complexity, the absence of some expert who can
teach or back the colleagues up in case of complications and the
understandable fear of causing the death or seriously harming the
affected children are important factor preventing the development
of a new airway team in many Institutions. Some possible theoret-
ical solutions to each problem can be found in Table 1. The way
we have been following to organize a new airway team in our In-
stitution was summarized in Table 2.
The goal of our airway team, consistent with the mission of
our pediatric Institution, one of the largest in our Country, was
to be able to take care of all airway related problems in children.
To do that, we had to define competencies following the princi-
ple that each specialist was the leader of an area, and that the
areas of competence should not be overlapping. Apart from obvi-
ous assignments (anesthesiologists were in charge for preoperative
evaluation and intraoperative medical management, cardiovascular
surgeons for procedures requiring cardiopulmonary bypass etc.), in
some cases we had to decide “by default” who was expected to
do what: diagnostic endoscopic procedures and endoscopic surg-
eries were assigned to ENT (for larynx and cervical trachea) or pul-
monologist (low trachea, bronchi). Tracheotomies were assigned to
ENT, while all the open procedures were assigned to the airway
trained pediatric surgeons, in cooperation (if necessary) with ENT
or cardiovascular surgeons. In our Institution, all anesthesiologist
and intensivists were trained to perform a flexible endoscopy, that
could be useful during surgery or in the post-operative period. A
pediatric surgeon was identified as the team leader, and specialist
nurses were assigned to be part of the team, with the task of co-
ordination of clinical evaluations, procedures, follow-up, and to be
in contact with the families.
Starting regular weekly meetings represented a key step for the
team. Discussing and sharing cases taught to all members of the
team to take responsibility of all difficulties and helped them to
find a shared solution.
To bridge the gap due to lack of experience, each of the profes-
sionals was sent to specialized Centers abroad. The pediatric sur-
geon who was in charge of the open procedures, which had never
been performed in our Institution before, was sent to GOSH Tra-
cheal Team for a one-year fellowship. This period not only taught
us how to manage the airway patients but also inspired us on the
way to create the team and how this had to function.
To be assisted during surgeries, we proudly met prof. Philippe
Monnier from CHUV of Lausanne, one of the most experts in the
world among airway surgeons, who was a perfect tutor of our
surgeons during the first years of activity. The airway cases were
scheduled and operated when the mentor was present. Since the
beginning, the principle of the tutoring was that the local team
had to grow and learn gradually to be independent in perform-
ing the procedures under prof. Monnier supervision. He was avail-
able also for pre-operative selection of the cases and for post-
operative management suggestions. During the first years, despite
M. Torre, R. D’Agostino, I. Fiz et al.
Table 1
Difficulties and problems commonly encountered before and during airway team setting and possible theoretical solutions.
Difficulty/Problem
Overlapping and lacking competences
Fragmentation of cases between clinical groups
Often challenging cases, not suitable for learning curve
Small numbers every year
Professionals not used to share experiences and discuss
Different visions and approaches between different professionals
Fear
Economical burden for the new technology
Table 2
Actions taken in our Institute to create an airway team.
Establishing Goals (what we want to be able to do)
Competence collection (who is doing what now)
Competence extension (what can be learned by whom and how)
Leadership (who is in charge to the airway team setting)
Internal coordination and adaptation to local environment
Regular Meeting
Tutoring
Review complications, mortality and morbidity
Improvement actions
Research
a quite good surgical activity,3 we have been observing a signif-
icant number of complications, that prompted us to review our
management protocols.4 Regular morbidity and mortality meetings
and a database were the instruments for monitoring our activity
and identifying areas of weakness with the possible improvement
actions. One example of these was represented by pre-operative
antibiotic prophylaxis (or therapy) in airway patients. After adopt-
ing a much more aggressive pre-operative antibiotic treatment, we
have been observing a significant improvement of surgical results,
as previously reported4 .
An important factor for the implementation of many institu-
tional airway teams, including ours, was the attendance to special-
ized meetings on airway surgery. More and more people from dif-
ferent centers became interested in pediatric airway surgery, and
focused meetings became more frequent. South America was the
area of the world where these meetings were particularly frequent,
thanks to the work of different dedicated groups (especially in
Chile, Argentina and Brazil) who were starting to organize them-
selves as Pediatric Airway Teams. These meetings were particularly
successful because pediatricians and surgeons from multiple spe-
cialties were starting to chat about practical management of air-
way patients. In these meetings, the sprouting new teams from
South America and elsewhere could not only share a lot of prac-
tical knowledge and experience in managing difficult clinical situ-
ations, but also find a young and enthusiastic community of peo-
ple with different origins and specializations, that was available to
support less experienced professionals. It became common, for ex-
ample, to organize local surgical workshops where difficult cases
were operated together with more experienced surgeons, or in ev-
ery time of the year to share difficult cases with the community
and receive answers and advices in a very short time.
Another important step for the development and implementa-
tion of the airway team in our Institution was the possibility to
pick up critically ill patients from other Hospitals (also abroad the
Country) and transport them to our Institution, including patients
in ECMO. This facility, made possible by our Intensivist Transport
Service, enlarged the number of patients referred to us (Fig. 1). The
same hospital that used to send the airway patients abroad was,
after few years, attracting patients from abroad.
To show how an airway team can function, we briefly describe
the pathway of some patients, managed in our team during the
3
Seminars in Pediatric Surgery 30 (2021) 151051
Possible solution
Assignment to different tasks to the specialists
Patient centered model
Tutor; sharing difficult cases in groups of experts
Centralization of cases
Weekly meeting
Weekly meeting; external advice; tutor
Tutor
Reduction of costs thanks to organized team
last few months, demonstrating typical simple or more compli-
cated clinical situations:
Case 1: Patient operated at 2.5 months for ventricular septum
defect. After 3 weeks at home he presented stridor during a res-
piratory infection. Pulmonologist was called and he performed a
flexible endoscopy, showing a subglottic stenosis grade 2. He di-
lated the stenosis with a 6 mm. balloon with an immediate good
result. The patient was presented at airway multidisciplinary meet-
ing and assigned to the otolaryngologists, who performed a second
dilatation and are now following-up.
Case 2: 4-year old girl with VATER syndrome, operated at birth
for type 3 esophageal atresia . She was referred to pulmonologist
for chronic respiratory symptoms (recurrent infections, cough and
noisy breathing). CT scan showed an anterior compression by in-
nominate artery, reducing tracheal lumen for more than 60%. The
double endoscopy showed: a left vocal cord palsy, a grade 1 to
2 subglottic stenosis, a recurrent distal tracheo-esophageal fistula
(TEF) and a severe tracheomalacia. The case was presented at the
airway team meeting and it was decided to perform an endoscopic
closure of the TEF as first step,which was performed by ENT sur-
geons using trichloroacetic acid.
After one month a bronchoscopy was performed that showed
grade 2 subglottic stenosis, satisfactory closure of TEF and severe
middle trachea tracheomalacia with anterior vascular compression.
Later on, the patient was operated at the same time by pediatric
surgeons who performed an open laryngotracheal reconstruction
(LTR) with an anterior graft and by the cardiovascular surgeons
who performed an anterior aortopexy through a mini-sternotomy.
The patient in actually asymptpmatic in follow-up by pulmonolo-
gists.
Discussion
The cases described demonstrate well how a multidisciplinary
approach offers the solutions that challenging situations require.
In this view, it is not important to which unit or department the
patient was initially referred, but what he needs. The same patient
will be treated accordingly by the right specialist, or by a com-
bination of professionals, and the case manager will change ac-
cordingly. For example, case n. 1, a patient with unknown origin
stridor, was evaluated by pulmonologists initially, but when diag-
nosis was established (post-intubation subglottic stenosis) he was
taken in charge by otolaryngologists. In the other case the man-
agement was combined, and during the same anesthesia multiple
procedures were organized. All the team members are involved in
every step of the treatment and kept updated of the outcome.
Apart from the obvious advantages of managing difficult airway
patients as a multidisciplinary team, some points remain to be dis-
cussed.
First, is it advantageous to have an airway team? The experi-
ence of aerodigestive teams, in particular in US, demonstrated that
they are beneficial in many ways: they reduce unnecessary test-
ing, they allow a reduction in costs for the healthcare system and
for the families, they promote the development of new procedures,
M. Torre, R. D’Agostino, I. Fiz et al.
Fig. 1. The graphic shows of our airway team since its creation. Only the major open tracheal reconstructive surgeries were considered.
Legend:
LTR: Laringo-Tracheal Reconstruction
PCTR/TR: Partial Crico-Tracheal Resection/ Tracheal Resection
Slide T-P: Slide Tracheoplasty
PT: Posterior Tracheopexy
and they are supportive for professionals involved5-8 . In practical
terms, this represents an advantage for both patients families and
Institutions. The reduction of the costs thanks to a better organi-
zation is a particularly important factor pushing towards the im-
plementation of airway teams and it could help to overcome the
increased expenses due to the new requirements of the team (in-
struments, technology, etc.)
Having a team can also increase the number of referrals. We
have observed this trend in our Institution, as shown in Fig. 1 (also
considering general reduction of surgical procedures in all the Hos-
pital due to pandemia and operative theatres limitations in 2020).
How the team should be composed and which patients should
manage is another matter of discussion. A consensus paper on
functions and composition of an aerodigestive team has been pub-
lished in 2018, based on the opinion of a multidisciplinary and
multicenter expert panel, using the Delphi method.9 The panel was
composed of 33 specialists from 11 aerodigestive centers in the
United States (12 pediatric pulmonologists, 11 pediatric otolaryn-
gologists, 8 pediatric gastroenterologists, and 2 speech language
pathologists). According to the experts, aerodigestive teams are fo-
cused on patients with a broad range of different symptoms, some
more related to feeding difficulties and congenital or chronic con-
ditions (as patients with failure to thrive, or with lung, genetic,
neurodevelopmental or craniofacial anomalies), others more “sur-
gical”, as patients with esophageal atresia, laryngotracheal steno-
sis, cleft). Interestingly, the medical specialties considered as “core
members”, with input required for all patients, were: gastroen-
terology, pulmonology, otolaryngology, speech-language pathology,
to which two other non medical professions -coordination and
nursing- were added. This probably reflects the composition of
the expert panel who drafted this consensus statement. Pediatric
surgery, anesthesia, critical care medicine, cardiothoracic surgery,
radiology, were all considered as non core disciplines, available for
sporadic consultations. In our Institution, instead, the presence of
all these is considered as essential for the discussion of all cases at
the weekly meeting. A number of other disciplines and non medi-
cal members are deemed essential for the team (speech therapist,
sleep medicine, respiratory therapist, dietician, occupational ther-
apy, social workers, etc..) that are probably available in all US hos-
4
Seminars in Pediatric Surgery 30 (2021) 151051
pital but are positions not regularly present or even not existent in
many other contexts.
Another model of airway team far from US is GOSH airway
team.10 , 11 This is a model probably more surgically focused than
the US aerodigestive teams, in particular on tracheal surgery. In
their paradigm, surgical members (cardiothoracic, general pediatric
surgeon, otolaryngologist) have a main role, and the role of other
professions (pulmonology, gastroenterology, speech-language and
respiratory therapy) is focused to prepare or follow the surgery.
Interestingly, they adapted some role to specific needs (the inter-
ventional radiologist was trained in airway endoscopy so he could
perform bronchography and bronchoscopy at the same time). After
the setting of GOSH team, they reported increase in referral, im-
proved outcomes, and a dramatic reduction in the cost of care.10
From these experiences, we can state that there is not a “one-
size-fits-all” model of airway team, and that it is probably neces-
sary to adapt the organization to everyone specific need and con-
text.
Some basical requirements are, however, necessary in an Insti-
tution where an airway team will be created. For example, the pos-
sibility of performing triple endoscopy (flexible and rigid airway
and esophago-stomach-duodenum endoscopy), the availability of
the equipment for operative endoscopy, the presence of a neonatal
and pediatric intensive care unit and of a cardiovascular unit, with
the possibility to perform a procedure on cardiopulmonary bypass
or ECMO. In absence of one of these facilities, it is probably bet-
ter to refer the patient elsewhere before doing everything. Even a
“simple” endoscopic evaluation under anesthesia could be trans-
formed in a disaster in an inappropriate environment. In our ex-
perience, for example, an infant with a severe congenital tracheal
stenosis with complete tracheal rings could become a very critical
patient after a simple bronchoscopy, when mucosal edema occurs
on an already reduced tracheal lumen. In this situation, the only
way to oxygenate the patient could be ECMO and tracheal stenosis
repair become an emergency procedure.
Is an airway team required in all hospitals? In our opinion, it
depends on the kind of hospital it is. If the hospital is a tertiary
referral center, treats often premature babies, has cardiac surgery,
attracts patients from all Country or elsewhere for surgical repairs,
M. Torre, R. D’Agostino, I. Fiz et al.
it is probably logical to set an airway team, as there will be the
need to treat airway patients and it is usually more convenient
to do it on your own than to send them elsewhere. If the center
is smaller, there is no cardiac surgery, or there is another airway
team already established near to you, it is probably not logical to
make the big effort of creating another airway team.
Which criteria should an airway team have, how many airway
teams should exist per habitant or per Country and which patients
should be treated in an airway team center only remain to be de-
termined at a political level. Establishing these criteria by public
health managers could help significantly the care of these chil-
dren. In UK, health authorities recognized the reported reduction
of costs thanks to centralized care of the difficult airway patients10
and established that every pediatric patient with complex tracheal
diseases has to be referred to GOSH tracheal team. The fact that
centralization of care in tracheal surgery helps to improve the out-
comes and reduce the costs is probably true not only in United
Kingdom, but centralization of uncommon and challenging patients
is far from the usual habit in the management of airway patients
in many geographical areas. In the future, a lot of efforts should
be spent in this direction if we hope to change the outcomes of
airway patients. It is well known, in fact, that the first treatment
is the most important for the final outcome, and for this reason
every airway patient should be referred initially in a team with
established airway team and not only in case of unsuccess after
the first attempt. It would be probably better to establish clear,
measurable and widely accepted criteria for dividing the centers in
those which can treat all kind of problems and those which should
better refer the patients elsewhere.
It can be questionable if in a single institution it is necessary to
determine by default which should be the area of action of the sin-
gle professionals or if this can be left unregulated. In other worlds,
is it necessary to regulate diagnostic and therapeutic pathways in
order to avoid that more professionals do the same procedure in
the same hospital? To divide the tasks between different profes-
sionals can be not easy (someone has to renounce to do some-
thing) and could raise (more or less open) argues, but in our opin-
ion it is convenient for the following reason: in the same hospital
both for the patient and the administration it is more simple and
clear to have single and definite more than multiple and different
pathways. Moreover, if every single professional has a definite own
area of expertise, he will have more responsibility and the possibil-
ity to become the real expert in this field. To have restricted area
of action give to each one a more focused objective and can help
to become excellent in the field.11
A final comment is reserved to the sprouting of new airway
teams in many parts of the world. As said above, this need is com-
mon in many contexts, however, it can be surprising that this pro-
cess was so successful in so many cases, although all the difficul-
ties presented. In our opinion, the teamwork on airway patients
was particularly successful due to different reasons. These patients
are quite uncommon but very challenging. It is difficult for every-
one to have a lot of experience in treating them. This makes quite
natural to look for help. But it is less obvious that this help was
found in a big amount, thanks to the availability of some world
“big experts” of the field (among the others, Robin Cotton, Mar-
tin Elliott, Philippe Monnier, Mike Rutter, Patricio Varela) to share
their knowledge and serve as teacher or tutor for less experienced
surgeons during the workshops and in many other opportunities.
This made the difference. Thanks to them, the seeds that helped
to create airway teams in many parts of the world were spread. A
second not obvious factor that was crucial for a successful develop-
ment of airway teams is the true friendship among the members
of many raising teams. It was common that after the airway course
an entire day was spent in social activities. This helped to create a
friendship atmosphere that really backed up many of us during our
5
Seminars in Pediatric Surgery 30 (2021) 151051
first years of airway activity. Thanks to this community (that was
called “Airway Family”), it was easier for everyone of us to over-
come the natural fear of making new difficult things and the frus-
tration whenever something was not going perfectly well. It was
natural for us to celebrate the successes with the others and ask
for opinions in case of doubt. Many of us travelled to other places
to help other surgeons in difficult cases. In our opinion this factor
was something difficult to find among surgeons, who are more of-
ten in a mood of competition more than of assistance towards the
others colleagues.
Future directions
Airway surgery is a rapidly evolving matter, as are all medicine
fields. We can expect big changes in the management of these pa-
tients, thanks to new technology and scientific progress. Regarding
the topic of the paper, focused on teamwork, the trend and the
efforts are towards the implementation of a worldwide network
of airway teams. INPAT (International Network of Pediatric Airway
Teams) is a recently born network of airway teams from every part
of the world, that gathered already twice in Italy (Genoa in 2017
and Rome in 2019) in multidisciplinary meetings organized thanks
to the sinergy between two big Italian pediatric hospital (Giannina
Gaslini and Bambino Gesù). The background that led to create IN-
PAT was a community of people with multiple specializations but
all interested in pediatric airway, interacting between them and
sharing clinical cases thanks to social media and Apps.
INPAT was a useful tool to launch multicenter studies on rare
conditions, as demonstrated by the paper on pediatric airway tu-
mors.12 On clinical research corner, other multicenter networks
and groups were able to work together on specific airway topics
in order to establish common goals, protocols or consensus state-
ments.13 , 14
If in the past the challenge for the single Institutions was the
creation of an airway team, now it is the time for all the airway
team to cooperate and work as a “team of teams”, thus multiplying
the benefits of the teamwork on a worldwide scale.
Acknowledgements
Thanks to Dr. Pietro Tuo who wanted strongly to set up an air-
way team in our hospital and all who cooperated to make it pos-
sible
Thanks to Claudia Schweiger and Patricio Varela for revising
and improving the manuscript. A special thanks to Philippe Mon-
nier for his unique dedication to help our team and many others
in the world.
Thanks to all the members of Airway Family, in every part of
the world they are
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