High-flow nasal oxygen in perioperative and critical care: a bibliometric analysis

High-flow nasal oxygen (HFNO), also known as high-flow nasal cannula, is an important noninvasive respiratory support strategy in perioperative and critical care practice. As the literature has expanded across multiple clinical contexts, a structured overview is needed to clarify the development, knowledge base, and emerging priorities of the field.

We conducted a bibliometric and visual analysis of HFNO research using English-language articles and reviews retrieved from the Web of Science Core Collection, Scopus, and PubMed for the period 2000-2025. After screening, merging, and deduplication, 2,314 unique publications were included. Bibliometrix in R was used for performance analysis, thematic mapping, and thematic evolution; VOSviewer for collaboration analysis; and CiteSpace for co-citation analysis, keyword clustering, timeline visualization, burst detection, and dual-map overlay.

HFNO research showed sustained exponential growth, with marked acceleration after 2018 and especially after 2020. The literature was concentrated in respiratory medicine, critical care, and anesthesiology journals, with Respiratory Care ranking first in publication output. The United States and China were the leading contributors, while several French institutions, particularly Assistance Publique-Hôpitaux de Paris, were prominent in the institutional network. Co-citation analysis identified major clusters related to acute respiratory failure, perioperative oxygen therapy, preoxygenation strategies, and coronavirus disease. Keyword and thematic analyses indicated a shift from early emphasis on perioperative oxygenation and postoperative respiratory support toward broader critical care application and, more recently, toward context-specific deployment, acute hypoxemic respiratory failure, awake prone positioning, treatment monitoring, and the ROX index.

HFNO research has evolved from a focused literature on oxygenation support into a broader and more clinically differentiated field spanning perioperative and critical care practice. Current hotspots are increasingly centered on context-specific use, monitoring, failure prediction, and escalation decisions. Future research should prioritize clinically actionable patient stratification, standardized outcome definitions, and protocol-based integration of HFNO across different care pathways.