Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

[Usefulness of induced sputum cytology in the study of central masses in elderly patients]

OBJECTIVE

To analyze the diagnostic yield of cytology obtained by means of sputum induction in elderly patients with central masses.

METHODS

A total of 23 patients older than 75 years with centrally located pulmonary masses identified by computerized tomography were studied. All patients collected three spontaneously produced sputum specimens and underwent three sputum-induction sessions. Induction was considered satisfactory when the patient expectorated within the following 15 minutes. All sputum specimens were processed by May-Grünwald-Giemsa and Papanicolau staining techniques. The definite diagnostic was considered that obtained by means of bronchial biopsy or chest percutaneous aspirative puncture (PAP).

RESULTS

With sputum induction, 19 patients (83%) collected satisfactory specimens and in 14 cases cytology was positive for malignancy (sensitivity 74%) and negative in five. No false-positive cases were recorded and in no patient did complications occur in association with sputum induction. The analysis of agreement between induced sputum and definite diagnosis showed a kappa index of 0.66.

CONCLUSIONS

Among elderly patients with central pulmonary masses, the cytology of induced sputum should be considered as the first diagnostic procedure because of its harmlessness, remarkable sensitivity and high histologic correlation.