Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections.

INTRODUCTION: Noninvasive respiratory support (NRS) such as noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) have been used in the treatment of acute hypoxemic respiratory failure (AHRF) related to the coronavirus disease (COVID-19) and other viral infections. However, there is a lack of consensus in favor of or against NRS use due to the risks of worsening hypoxemia, intubation delay, and aerosols environmental contamination associated with the use of these tools. We aimed to summarize the evidence on the use of NRS in adult patients with COVID-19 and other viral pneumonia (i.e. H1N1, SARS, MERS) and AHRF. We also searched for studies evaluating the risk of aerosolization/contamination with these tools. EVIDENCE ACQUISITION: We searched MEDLINE, PubMed EMBASE and two major preprint servers (biorXiv and medRxiv) from inception to April 14, 2020, for studies on the use of respiratory support in AHRF and viral pneumonia. EVIDENCE SYNTHESIS: The search identified 4086 records and we found only one randomized controlled trial out of 58 studies included, with great variabilities in support utilization and failure rates. Fifteen studies explored the issue of aerosolization/contamination showing a high risk of airborne transmission via droplets generation during the use of these modalities. CONCLUSIONS: Use of NRS and treatment failure in the context of COVID-19 and viral infection associated-AHRF, varied widely. Dispersion of exhaled air is different depending on the type of respiratory therapies and interfaces. Data from randomized controlled trials are lacking.

Practical considerations for spirometry during the COVID-19 outbreak: Literature review and insights.

BACKGROUND: As the Coronavirus disease 2019 (COVID-19) is spreading worldwide, countries are dealing with different phases of the pandemic. Lately, scientific evidence has been growing about the measures for reopening respiratory outpatient services during the COVID-19 pandemic. We aim to summarize the key differences and similarities among recommendations by different national and international organizations. METHODS: We searched on Google and Pubmed for recently published National and International Recommendations/Guidelines/Position Papers from professional organizations and societies, offering a guidance to physicians on how to safely perform pulmonary function testing during COVID-19 pandemic. We also searched for spirometry manufacturers' operational indications. RESULTS: Indications on spirometry were released by the Chinese Task force, the American Thoracic Society, the European Respiratory Society, the Thoracic Society of Australia and New Zealand, the Société de Pneumologie de Langue Française, the Spanish Societies (Sociedad Espanola de Neumologia y Cirugia Toracica, Sociedad Espanola de Alergologia e Inmunologia Clinica, Asociacion de Especialistas en Enfermeria del trabajo, Asociacion de Enfermeria Comunitaria), the Sociedade Portuguesa de Pneumologia, the British Thoracic Society/Association for Respiratory Technology & Physiology, the Irish Thoracic Society, the Sociedad Uruguaya de Neumologia, the Italian Thoracic Society and the Italian Respiratory Society, Cleveland Clinic and Nebraska Medical Center. Detailed technical recommendations were found on manufacturers' websites. We found several similarities across available guidelines for safely resuming pulmonary function services, as well as differences in criteria for selecting eligible patients for which spirometry is deemed essential and advice which was not homogenous on room ventilation precautions. CONCLUSIONS: This study shows a synthesis of national/international guidelines allowing practicing physicians to adapt and shape the way to organize their outpatient services locally. There is generally good agreement on the importance of limiting pulmonary function testing to selected cases only. However, significant differences concerning the subsets of candidate patients, as well as on the management of adequate room ventilation, were observed.

Resumption of respiratory outpatient services in the COVID-19 era: Experience from Southern Italy.

COVID-19 pandemic turned the entire health-care system organization upside-down, suspending elective activities and outpatient services. In Italy, we are entering a second phase of the pandemic and several strategies have been developed to "re-open" the country, some businesses, and also health care outpatient activities. This manuscript describes the experience of a Southern Italy Respiratory Unit for safely resuming outpatient respiratory services and preventing COVID-19 transmission.