Pulmonologists and respiratory intensive care

In several countries, particularly North America, inten-sive care medicine is closely linked to pulmonology. Thecurriculum of pulmonologists in training has an obliga-tory period in the Intensive Care Unit (ICU). In mostEuropean countries, pulmonologists do not have any roleor have only a very small role in the treatment of severefailure of the lung and thoracic pump, which is their fieldof specialization. More importantly, in Europe in the 4yrs of training needed to become a European Community(EC) certified pulmonologist, a period in the ICU is notincluded. This is to say that a general physician canbecome a pulmonologist without having been exposedto the complex procedures [1] and problems [2] leadingto the diagnosis, monitoring, treatment and managementof patients with severe respiratory failure.The fact that pulmonologists are not exposed to res-piratory intensive care problems has important and mul-tifactorial implications. Firstly, fundamental exposure tothe pathophysiology and treatment of respiratory diseasesis missed. Secondly, early exposure to critical care prob-lems would allow pulmonologists to consider the possi-bilities of following a career in respiratory intensive care.Thus, in addition to educational benefits, such exposuremight open up new horizons for young pulmonologists.In our view, therefore, it is essential that, in the future,an effort should be made to ensure that the curriculumof new pulmonologists includes the experience of step-down or intermediate care units or chronic home ven-tilatory assistance for chronic respiratory failure, whichcould help to reduce the general ICU cost [3–5]. In thesesettings, experienced pneumologists/intensivists have andshould play an important role.The European Respiratory Society (ERS) has a spe-cial interest in increasing the involvement of pulmo-nologists in intensive care medicine. Efforts are beingmade by the Scientific Assembly of Respiratory IntensiveCare to promote this discipline during ERS Congresses,as well as by institution of task forces and interactionwith the European Society of Intensive Care Medicine(ESICM) and the American Thoracic Society (ATS). Inaddition to those efforts, the European Respiratory Journalhas created a new series on Clinical Physiology inRespiratory Intensive Care, which begins in this issueof the Journal. In this series, a number of review arti-cles from internationally recognized experts will be pub-lished covering many aspects of the pathophysiologyinvolved in respiratory intensive care medicine, with par-ticular attention to clinical applications.We hope that this series will be highly educational andwill also promote the interest of pulmonologists in inten-sive care medicine.