Acceptability of advanced monitoring for acute respiratory failure requiring non-invasive respiratory support: A qualitative study of perceptions from patients and critical care practitioners

BACKGROUND: Advanced monitoring instruments can provide detailed assessment of work of breathing in patients with acute hypoxaemic respiratory failure (AHRF) managed with non-invasive respiratory support (NRS). Despite increasing availability, uptake in routine clinical practice remains limited. Beyond technical performance, implementation depends on acceptability to both patients and healthcare practitioners. This study explored perceptions of acceptability to inform sustainable clinical implementation. METHODS: We conducted a multicentre qualitative study across two hospitals. Semi-structured interviews were undertaken with former adult patients who experienced AHRF requiring non-invasive respiratory support (n = 10) and multidisciplinary critical care practitioners (n = 20). Data were analysed using reflexive thematic analysis and mapped to the Theoretical Framework of Acceptability. RESULTS: Patients described AHRF and non-invasive respiratory support as distressing experiences characterised by fear, sensory overload, loss of agency, and physical discomfort. Acceptability of advanced monitoring was highly conditional: non-invasive, non-restrictive instruments were favoured, particularly when visual feedback enhanced understanding and reassurance. Invasive or cumbersome monitoring was rejected due to added distress and perceived ethical burden, although some patients retrospectively tolerated discomfort reflecting on survival benefit. Practitioners described AHRF assessment and delivery of non-invasive respiratory support as cognitively demanding and complex, shaped by uncertainty, workload, time pressure, and limited standardised guidance. Monitoring was acceptable when intuitive, easy to interpret, feasible within workflow, and informed clinical decision-making. Visual, real-time, low-burden, non-invasive modalities were viewed favourably, whereas invasive or technically complex tools raised concerns regarding patient distress, training requirements, and feasibility. CONCLUSION: Acceptability of advanced respiratory monitoring during non-invasive respiratory support is shaped by lived experience of illness, treatment burden, and clinical uncertainty. Instruments that are non-invasive, visually interpretable, and clinically meaningful are most acceptable to patients and practitioners. IMPLICATIONS FOR CLINICAL PRACTICE: Advanced respiratory monitoring appears most acceptable when non-invasive, visually interpretable, and feasible within routine workflows. Monitoring providing clear, real-time information without adding patient burden can enhance patient engagement and support clinical assessment, multidisciplinary communication, and decision-making. Implementation should prioritise structured training, and integration within standardised care pathways to maximise clinical value without increasing workload.