National survey on training and clinical practice of the Pneumologist in Respiratory Intensive Care

Background. Despite the expansion of respiratory intensivology (IR) in the last 15 years in Italy, there are so far no data concerning the training and the clinical activity of the pneumologist in IR. Aim. To analyse with a survey the training and the clinical practice of the pneumologist in IR. Methods. The survey was performed in 2007 via web by sending a 26-items questionnaire to the 315 pneumologists belonging to the AIPO Study Group of Respiratory Intensive Care. Results. The rate of response to the questionnaire was of 81.9%. 215 pneumologists (68.3%) with a stated interest for IR (male gender: 87%; age > 35 years: 94.3%; belonging to Hospital Pulmonology: 69.4%) were included into the study. Training in IR during the university specialty was believed insufficient in 97.3% of cases. For each of the 8 considered IR activities, training occurred more often in the working environment (range: 21.7-74.0%) than during the university specialty (range: 1.4-38.4%), with a length < 1 year in 60.9% of cases; no training at all was received for 6 out of 8 IR activities (range: 20.5-67.4%). In > 50% cases, utility of guidelines and need for considering the majority of IR activities as part of the clinical store of the pneumologist was declared. In 96.6% of cases, Respiratory Intensive Care Unit was considered as the setting where to perform noninvasive ventilation. The autonomy in performing IR activities in the clinical practice turns out to be heterogeneous (range: 2.9-94.3%) with values > 70% only for fiberoptic bronchoscopy, cardio-pulmonary resuscitation, noninvasive monitoring and noninvasive ventilation. Conclusions. From this survey for the pneumologist emerged the existence of a gap between the importance to have IR within his own clinical store and the inadequacy of the university training received. It is required to improve the training of the pneumologist to give him/her the instruments needed for the clinical management of the respiratory critical patient.