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The FLORALI randomised trial compared high-flow nasal oxygen, standard oxygen and noninvasive ventilation in adults with nonhypercapnic acute hypoxaemic respiratory failure. Although the primary outcome of intubation rate did not differ significantly among the groups, patients receiving high-flow oxygen had more ventilator-free days and lower 90-day mortality than those receiving standard oxygen or noninvasive ventilation in the trial population. The study helped establish high-flow nasal oxygen as an important option in acute hypoxaemic respiratory failure. Its benefits likely extend beyond oxygen delivery alone, including improved comfort, humidification and washout of upper-airway dead space. For HCPs, the key message is that high-flow oxygen is not simply “more oxygen.” It is a form of respiratory support that should be monitored for work of breathing, gas exchange and clinical trajectory. Delayed intubation remains a potential hazard when non-invasive support creates a false sense of stability. The paper fits CritiCARE 2026 sessions on non-invasive ventilation, respiratory critical care and escalation decisions. Clinicians should combine physiological assessment with frequent reassessment rather than waiting for a single numerical threshold before deciding whether support is succeeding.
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The FLORALI randomised trial compared high-flow nasal oxygen, standard oxygen and noninvasive ventilation in adults with nonhypercapnic acute hypoxaemic respiratory failure. Although the primary outcome of intubation rate did not differ significantly among the groups, patients receiving high-flow oxygen had more ventilator-free days and lower 90-day mortality than those receiving standard oxygen or noninvasive ventilation in the trial population. The study helped establish high-flow nasal oxygen as an important option in acute hypoxaemic respiratory failure. Its benefits likely extend beyond oxygen delivery alone, including improved comfort, humidification and washout of upper-airway dead space. For HCPs, the key message is that high-flow oxygen is not simply “more oxygen.” It is a form of respiratory support that should be monitored for work of breathing, gas exchange and clinical trajectory. Delayed intubation remains a potential hazard when non-invasive support creates a false sense of stability. The paper fits CritiCARE 2026 sessions on non-invasive ventilation, respiratory critical care and escalation decisions. Clinicians should combine physiological assessment with frequent reassessment rather than waiting for a single numerical threshold before deciding whether support is succeeding.
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