Sedation Practices in Interventional Pulmonology (SEDIP): Results of an Italian Cross-Sectional Survey

BACKGROUND: Sedation has become an essential component of modern interventional pulmonology, accompanying the progressive expansion of bronchoscopic procedures from conventional diagnostic bronchoscopy to advanced diagnostic and therapeutic airway interventions. Despite its increasing relevance, sedation practices remain heterogeneous, and dedicated national recommendations specifically addressing interventional pulmonology are still lacking in many countries. METHODS: A national cross-sectional survey was conducted among physicians involved in interventional pulmonology practice through the Accademia di Ecografia Toracica (ADET) network. The questionnaire consisted of 29 structured items covering organizational models, pharmacological strategies, monitoring approaches, and safety-related aspects of procedural sedation. Responses were analyzed descriptively using proportions, medians, and interquartile ranges. Agreement was operationally defined as a Likert score of 4-5 in at least 70% of responses. RESULTS: Forty-one responses were included in the final analysis. Sedation was routinely integrated into procedural activity in most centers, although relevant variability emerged regarding sedation management, monitoring practices, and anesthesiology involvement. The strongest agreement concerned the need for national recommendations to standardize sedation practices (80.5% agreement), followed by recognition that anesthesiologist presence is required during high-risk interventional procedures (73.2%). Substantial agreement emerged regarding pulmonologist-led moderate sedation in selected settings (68.3%), while capnography did not reach clear consensus (44.7%). Limited anesthesia availability was considered a relevant organizational factor by 63.2% of respondents. CONCLUSIONS: Among participating clinicians, sedation was widely integrated into routine interventional pulmonology practice but remained organizationally heterogeneous. The survey identified broad agreement regarding the need for national harmonization and dedicated anesthesiology support for high-risk procedures. Given the network-based recruitment strategy and the absence of procedural volume data, these findings should be considered exploratory and hypothesis-generating rather than fully representative of national practice.