{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T22:26:10Z","timestamp":1788474370187,"version":"build-2803163510"},"reference-count":39,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2025,11,11]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2019 self-reported practices, perceptions and barriers regarding HFNT use in acute and chronic respiratory failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional web-based survey was disseminated among members of the European Respiratory Society\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003547","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:25:23Z","timestamp":1766049923000},"page":"e003547","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Practices of high-flow nasal therapy in acute and chronic respiratory failure: the Hi-Flow Survey"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9088-5214","authenticated-orcid":false,"given":"Claudia","family":"Crimi","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy"},{"name":"Respiratory Medicine and Respiratory Intensive Care Unit, Policlinico \"G. Rodolico-San Marco\" University Hospital, Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Noto","sequence":"additional","affiliation":[{"name":"Department of Human Pathology of the Adult and Evolutive Age \u201cGaetano Barresi\u201d, Division of Anesthesia and Intensive Care, University of Messina, Policlinico \u201cG. Martino\u201d, Messina, Italy, University of Messina, Messina, Sicily, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cortegiani","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy"},{"name":"Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7474-1467","authenticated-orcid":false,"given":"Annalisa","family":"Carlucci","sequence":"additional","affiliation":[{"name":"Dipartimento di Medicina e Chirurgia, University of Insubria, Varese, Lombardy, Italy"},{"name":"Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri SpA IRCCS, Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Gregoretti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Istituto G Giglio, Cefal\u00f9, Italy"},{"name":"Saint Camillus International University of Health and Medical Sciences, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deniz","family":"Inal-Ince","sequence":"additional","affiliation":[{"name":"Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1633-6356","authenticated-orcid":false,"given":"Frits M E M E","family":"Franssen","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands"},{"name":"Department of Research and Development, Ciro, Horn, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3247-2849","authenticated-orcid":false,"given":"Christian","family":"Karagiannidis","sequence":"additional","affiliation":[{"name":"Department of Pneumology and Critical Care Medicine, ARDS and ECMO Centre, Cologne-Merheim Hospital, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Carlos","family":"Winck","sequence":"additional","affiliation":[{"name":"UniC, Cardiovascular R&D, University of Porto, Porto, Portugal"},{"name":"Instituto CUF, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5833-1230","authenticated-orcid":false,"given":"Christoph","family":"Fisser","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Begum","family":"Ergan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Dokuz Eyl\u00fcl University, Alsancak, \u0130zmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Martin-Loeches","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James\u2019s Hospital, Dublin D08 NHY1, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Cysneiros","sequence":"additional","affiliation":[{"name":"Unidade de Urg\u00eancia M\u00e9dica, Centro Hospitalar Universit\u00e1rio de Lisboa Central EPE, Lisbon, Portugal"},{"name":"Nova Medical School, Universidade de Lisboa, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1366-8726","authenticated-orcid":false,"given":"Maxime","family":"Patout","sequence":"additional","affiliation":[{"name":"Groupe Hospitalier Universitaire APHP-Sorbonne Universit\u00e9, Site Piti\u00e9-Salp\u00eatri\u00e8re, Service des Pathologies du Sommeil (D\u00e9partement R3S), AP-HP, Paris, France"},{"name":"Department of INSERM, UMRS1158 Neurophysiologie Respiratoire Exp\u00e9rimentale et Clinique, F-75005 Paris, France, Sorbonne Universit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-9447","authenticated-orcid":false,"given":"Marieke","family":"Duiverman","sequence":"additional","affiliation":[{"name":"Department of Pulmonology and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands"},{"name":"Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8404-2085","authenticated-orcid":false,"given":"Stefano","family":"Nava","sequence":"additional","affiliation":[{"name":"Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria S. 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