High-flow nasal oxygen in acute hypoxemic respiratory failure: A narrative review of the evidence before and after the COVID-19 pandemic.

High-flow nasal oxygen (HFNO) is a type of non-invasive advanced respiratory support that allows the delivery of high-flow and humidified air through a nasal cannula. It can deliver a higher inspired oxygen fraction than conventional oxygen therapy (COT), improves secretion clearance, has a small positive end-expiratory pressure, and exhibits a washout effect on the upper air space that diminishes dead space ventilation. HFNO has been shown to reduce the work of breathing in acute hypoxemic respiratory failure (AHRF) and has become an interesting option for non-invasive respiratory support. Evidence published before the COVID-19 pandemic suggested a possible reduction of the need for invasive mechanical ventilation compared to COT. The COVID-19 pandemic has resulted in a substantial increase in AHRF worldwide, overwhelming both acute and intensive care unit capacity in most countries. This triggered new trials, adding to the body of evidence on HFNO in AHRF and its possible benefits compared to COT or non-invasive ventilation. We have summarized and discussed this recent evidence to inform the best supportive strategy in AHRF both related and unrelated to COVID-19.

[Etiological diagnosis of thyroid nodules†: collaborative approach between the internist and specialists]. / Diagnostic étiologique des nodules thyroïdiens - Approche collaborative entre le médecin de premier recours et les spécialistes.

One or more thyroid nodules, most often asymptomatic, may be found in more than half of the population, and they usually do not require specific therapeutic management, except for cancerous nodules. In order to avoid under-diagnosis and over-treatment, we propose a diagnostic strategy in line with current recommendations, based on the collaboration between general internist, radiologist, and endocrinologist. In addition to clinical information and thyroid function tests, thyroid ultrasound remains the first step in assessing the risk of nodule malignancy and setting the indication for fine needle aspiration. Cytology then makes it possible to define the therapeutic strategy, from an observation of the evolution to interventional, surgical or radiofrequency management.

Un ou plusieurs nodules thyroïdiens, le plus souvent asymptomatiques, peuvent être découverts chez plus de la moitié de la population, et dans la plupart des cas, ils ne nécessitent pas de prise en charge thérapeutique spécifique, sauf pour les nodules cancéreux. Afin d'éviter à la fois le sous-diagnostic et le surtraitement, nous proposons une stratégie diagnostique basée sur les recommandations actuelles, faisant appel à la collaboration entre l'interniste généraliste, le radiologue et l'endocrinologue. En complément aux informations cliniques et aux tests de la fonction thyroïdienne, l'ultrason de la thyroïde est l'examen de premier choix pour évaluer le risque de malignité du nodule et pour poser l'indication à la ponction à l'aiguille fine. La cytologie permet alors de définir la stratégie thérapeutique entre une observation de l'évolution ou une prise en charge interventionnelle, chirurgicale ou par radiofréquence.