Answer Happy

It is February. Mrs. Martinez, a 75-year-old Hispanic female patient of yours with a history of stable chronic obstructive pulmonary disease (COPD), has been admitted to the emergency department (ED) in your hospital for acute respiratory distress. She has had to use her nighttime oxygen therapy during the day for the past 24 hours and was scheduled to meet you in your clinic for general follow up when her son brought her instead to the ED as you were doing your daily patient rounds. She has an oxygen saturation of 86, rigor-type chills, difficulty breathing, extreme fatigue, a fever of 103 degrees Fahrenheit, and generalized weakness. Mr. Martinez stated that she has known exposure to a seasonal respiratory illness from one of her grandchildren, and her condition has been worsening for 2 days. You are waiting for her to be attended by the hospitalist physician, who is currently managing an emergency with another patient. Your task, as her Respiratory Therapist, is to help make some initial determinations for increasing her oxygen levels through breathing treatments, and to consider testing to rule out a diagnosis of suspected influenza.
The standard of care for testing for influenza in the hospital in this case is polymerase chain reaction (PCR) from a nasal swab sample. PCR takes 15 minutes to produce a result. PCR testing has a somewhat lower level of accuracy (sensitivity and specificity) than desired, in light of the patient’s COPD, which increases her risk for developing fatal pneumonia as a secondary infection associated with flu. Another form of testing available in the hospital is the nucleic acid amplification (NAA) test. The results can be returned in the same amount of time, but the relative level of accuracy between PCR and NAA is unknown. Taking a few minutes to perform an evidence-based search of the literature will provide insight into making the decision regarding which test to use in this case.
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