Beyond measures, what matters? Acceptability of advanced monitoring for acute respiratory failure during non-invasive respiratory support: perceptions from patients and critical care practitioners

Background: Advanced monitoring instruments can provide detailed assessments of work of breathing in patients with acute respiratory failure (ARF) treated with non-invasive respiratory support (NRS). However, their adoption remains sparse. Their clinical utility depends not only on accuracy but also on their acceptability to patients and practitioners. Aim: We explored perceptions of acceptability to inform clinical implementation. Methods: A multicentre qualitative study undertaking semi-structured interviews with former ARF patients requiring NRS (n=10) and multiprofessional critical care practitioners (n=20). Analysis used reflexive thematic analysis informed by the Theoretical Framework of Acceptability. Results: Patients reported greater acceptability for non-invasive instruments, which were perceived as less intrusive, uncomfortable, or restrictive. Additionally, visually accessible instruments were viewed as providing reassurance and enhanced engagement. Practitioners mentioned greater acceptability for instruments that were easy to use and interpret, perceived to be valuable, add diagnostic clarity and multidisciplinary applicability. Barriers included new training, workload, time-pressure and instrument availability. Cross-thematic analysis showed convergence around conditional acceptability when monitoring demonstrably informed clinical-decision making or improved outcomes. Conclusion: Advanced monitoring is acceptable when non-invasive, interpretable and clinically useful. Implementation will require training and guideline to enable sustainable adoption in clinical-decision making