Critically ill patients with cancer: A clinical perspective

Table 5 Invasive and noninvasive diagnostic procedures in cancer patients with acute respiratory failure[5]

Diagnostic procedure	Comments
Blood cultures	Hospital-acquired bacteria
Multislice or high-resolution CT scan	In most cases without contrast media; MRI if a pulmonary CT scan is not feasible
Echocardiography	Cardiac evaluation
Sputum examination	Bacteria; Fungi; Mycobacteria
Induced sputum	Pneumocystis jiroveci
Nasopharyngeal aspirates or nasal swabs	Adenovirus, metapneumovirus, coronavirus, parainfluenza virus types 1, 2, 3 and 4; influenza virus types A and B, respiratory syncytial virus A and B; rhinovirus A, B, and C; bocavirus and enterovirus
Polymerase chain reaction blood test	Herpesviridae; Cytomegalovirus; Epstein-Barr virus
Circulating Aspergillus galactomannan	Aspergillus spp.
Serologic tests	Chlamydia pneumoniae; Mycoplasma pneumoniae; Legionella pneumophila
Urine antigen	Legionella pneumophila; Streptococcus pneumoniae
BAL (mandatory)	(1) Cytospin preparation including Giemsa stain for cytological diagnostics and Gram stain; (2) Quantitative or semi-quantitative bacteriological cultures including culture media to detect Legionella spp., mycobacteria and fungi; (3) Calcofluor white or equivalent stain (assessment of fungi); (4) Quantitative (if possible) PCR for Pneumocystis jirovecii; (5) Direct immunofluorescence test for Pneumocystis jirovecii; (6) Aspergillus antigen (Galactomannan ELISA); and (7) Mycobacterium tuberculosis PCR, atypical mycobacteria
BAL (optional)	(1) PCR for cytomegalovirus, respiratory syncytial virus, influenza A/B virus, parainfluenza virus, human metapneumovirus, adenovirus, varicella zoster virus, and Pneumocystis jirovecii (quantitative); and (2) Aspergillus antigen (Galactomannan ELISA); Panfungal or Aspergillus/ mucormycetes PCR
Transbronchial biopsies	Not recommended in general in febrile neutropenic and/or thrombocytopenic patients as the first line procedure

CT: Computed tomography; BAL: Bronchoalveolar lavage; PCR: Polymerase chain reaction.