High-flow nasal cannula for acute respiratory failure: a bibliometric analysis of current trends and future directions.

BACKGROUND

High-flow nasal cannula (HFNC) oxygen therapy has emerged as a pivotal non-invasive respiratory support modality for acute respiratory failure (ARF), fundamentally transforming critical care practice. Despite substantial growth in HFNC research and clinical significance, no comprehensive bibliometric analysis has systematically examined the knowledge structure, research trends, and emerging frontiers in this rapidly evolving field.

METHODS

A comprehensive bibliometric analysis was conducted using the Web of Science Core Collection (WOSCC), supplemented by PubMed and Scopus for literature retrieval, covering publications from January 2015 to December 2025. Search terms included combinations of "acute respiratory failure," "respiratory failure," "ARF," "high-flow nasal oxygen," "high-flow oxygen," and "HFNC" in titles and abstracts. Data were analyzed using three visualization tools: CiteSpace (version 6.4.R1), VOSviewer (version 1.6.20), and Bibliometrix in R (version 4.5.1) to examine publication trends, country collaborations, author networks, journal distributions, co-citation patterns, and keyword evolution.

RESULTS

A total of 1,477 publications were identified, with annual output peaking at 256 in 2022, reflecting intensified research during the COVID-19 pandemic. The United States led in productivity (n = 139), while France achieved the highest citation impact (TC = 7,726). Keyword and co-citation clustering revealed evolving research foci from foundational respiratory support (2015-2017) to pandemic-driven applications (2019-2021) and emerging artificial intelligence (AI) integration (2022-2025). Nine distinct research clusters were identified, with recent emphasis on chronic obstructive pulmonary disease, reintubation, and advanced respiratory technologies.

CONCLUSION

The findings highlight HFNC's successful transition from experimental therapy to evidence-based standard care, with future trends indicating movement toward personalized medicine approaches and technology-enhanced respiratory care delivery systems.