Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: High-flow nasal therapy (HFNT) is a widely used non-invasive respiratory support technique, but data on its clinical application remain limited. This study aimed to assess clinicians' self-reported practices, perceptions and barriers regarding HFNT use in acute and chronic respiratory failure. METHODS: A cross-sectional web-based survey was disseminated among members of the European Respiratory Society's respiratory intensive care, rehabilitation and chronic care, and allied respiratory professionals assemblies from September to November 2023. Descriptive analysis was performed, with results presented as frequencies and percentages. RESULTS: A total of 1176 clinicians from 104 countries participated, primarily pulmonologists (78.3%) and respiratory therapists (9.7%). HFNT was most commonly used for de novo acute respiratory failure (56.2%) and interstitial lung disease exacerbations (56.3%), with lower utilisation for chronic obstructive pulmonary disease with hypercapnia (47.4%) and trauma/atelectasis (41.5%). Despite guideline recommendations, 67% of respondents initiated HFNT only after conventional oxygen therapy failure. HFNT was also frequently used for symptom relief in palliative care, despite limited supporting evidence. Respiratory distress was the primary clinical trigger for HFNT initiation, while the ROX (Respiratory Rate-Oxygenation) index was rarely used to guide escalation of care (32%). Barriers to HFNT adoption included equipment costs (23%), lack of funding (22%) and limited clinician knowledge (18%). HFNT use increased during the COVID-19 pandemic (84%), but long-term application for chronic respiratory failure remained rare (16%). CONCLUSIONS: This survey highlights significant variability in HFNT practices and a disconnect between guidelines and real-world implementation. Addressing financial and educational barriers may improve adherence to evidence-based recommendations.
Authors: Crimi, Claudia, Noto, Alberto, Cortegiani, Andrea, Carlucci, Annalisa, Gregoretti, Cesare, Inal-Ince, Deniz, Franssen, Frits M.E.M.E., Karagiannidis, Christian, Winck, Joao Carlos, Fisser, Christoph, Ergan, Begum, Martin-Loeches, Ignacio, Cysneiros, Ana, Patout, Maxime, Duiverman, Marieke, Nava, Stefano
Institutions: University of Catania, Policlinico Universitario di Catania, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", University of Messina, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, University of Palermo, University of Insubria, Istituti Clinici Scientifici Maugeri, Saint Camillus International University of Health and Medical Sciences, Fondazione Istituto G. Giglio di Cefalù, Hacettepe University, Maastricht University Medical Centre, Ciro, Universidade do Porto, Instituo CUF Porto, University Hospital Regensburg, Dokuz Eylül University, St. James's Hospital, University of Lisbon, Unidade Local de Saúde de São José, Universidade Nova de Lisboa, Inserm, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Neurophysiologie respiratoire expérimentale et clinique, University Medical Center Groningen, University of Groningen, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: European Respiratory Society
OpenAlex ID: W7130283935
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