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Currently conventional oxygen therapy is the first choice symptomatic treatment in the management of acute respiratory failure (ARF). However, conventional oxygen therapy has important limitations which have lead to the development of heated and humidified high-flow nasal oxygen therapy (HFNO). HFNO is an innovative technique that can deliver, through special nasal cannulae, up to 100% of the inspired fraction (FiO2) with heated and humidified oxygen at a maximum flow of 70L/min. The characteristics of this technique (overcoming the patient's spontaneous inspiratory flow, heated humidification,) and its physiological effects (no dilution of FiO2, positive end-expiratory pressure, pharyngeal dead-space washout, decrease in airway resistance), allow efficient optimization of oxygenation with better tolerance for patients. Current data, mainly observational, show that HFNO could be used particularly for the management of hypoxemic ARF, notably in the more severe forms. Indications for using HFNO, alone or in association with noninvasive ventilation, are potentially very broad and may involve different types of ARF (post-operative, post-extubation, palliative care) and even the practice of invasive technical procedures (bronchial fibroscopy). However, though current studies are very encouraging and promise a clinical benefit on patient outcomes, randomized trials are still needed to demonstrate that HFNO avoids the need for endotracheal intubation in the management of ARF.

Resume Introduction Les pneumopathies nosocomiales (PN) representent l’une des principales causes d’infection en reanimation responsable d’une morbidite, d’une mortalite et d’un surcout des soins non negligeables. Les pneumopathies nosocomiales acquises sous ventilation mecanique en represente la forme la plus frequente et la plus severe. Etat des connaissances L’evaluation de la qualite des soins et des pratiques professionnelles en matiere de PN represente un domaine potentiellement vaste mais encore tres limite a travers la litterature. Cette evaluation et son analyse se heurtent a des difficultes principalement representees par l’absence de « gold standard » diagnostique, de standardisation des techniques de prelevements microbiologiques et, de fait, par l’absence d’indicateurs de performance pertinents pour la prise en charge des PN. Actuellement, l’evaluation de la qualite des soins et des pratiques en matiere de PN concerne principalement les strategies diagnostiques, les mesures preventives et l’antibiotherapie. Perspectives et conclusions Cependant, a partir des dernieres recommandations publiees, de nombreux efforts devront etre encore fournis par les cliniciens dans ce domaine afin d’ameliorer la prise en charge et le cout des PN en reanimation.