High flow nasal therapy practices in acute and chronic respiratory failure: results from the ERS Hi-Flow survey

<bold>Background:</bold> There is limited data on high flow nasal therapy practices among clinicians. <bold>Objectives:</bold> To describe clinicians’ self-reported HFNT practices and perception <bold>Methods:</bold> The electronic survey was developed by a group of experts and disseminated through email to members of the European Respiratory Society assembly 2 respiratory intensive care, group 1.2 rehabilitation and chronic care, and group 9 physiotherapists from September to November 2023. Descriptive analysis was used, and data are reported as frequencies and percentages of the total number of survey respondents. <bold>Results:</bold> 1176 clinicians answered the survey. Most respondents (78.3%) identified as pulmonologists and 9.7% as respiratory therapists. Of the respondents, 40.6% worked in pulmonary ward with high dependency unit and 14.3% worked in intensive care units. The most common indication (56%) for HFNT was de novoacute respiratory failure; however, only 20% of clinicians chose it as first-line treatment and 67% used it in non-responders to conventional oxygen therapy. Indeed, 36% of respondents initiate HFNT in patients with P/F ratio between 100 and 200. More than 70% of respondents were more likely to consider discontinuing HFNT when it fails to achieve a target SpO2 and in presence of hypercapnia with respiratory acidosis, while inly 32% of clinicians used the ROX index to consider escalation of care. More than 80% of respondents perceived an increased use of HFNT during the pandemic. Only 16% of respondents are likely to prescribe long-term HFNT at home. <bold>Conclusions:</bold> Overall, HFNT is highly used in acute settings preferably in de novo respiratory failure, while rarely prescribed in the long-term.