In Line Aerosol Nebulization With High Flow

Inclusion Criteria: * Adults ≥ 18 years of age * Patients with mild or moderate hypoxemic respiratory failure (with or without acute hypercapnic respiratory failure) treated with HFNC. * Nebulizer therapy ordered by the primary team with at least one dose delivered prior to the enrollment into the study * Patients must be on ordered nebulized albuterol, levalbuterol, ipratropium or ipratropium/albuterol combination with a maximum of Q3 or a minimum of Q6 hour frequencies. * For Respiratory Therapists: They must be employees of SMICU or RRMC. Exclusion Criteria: * Lack of hypoxemia defined as SpO2\> 92% on room air * Severe hypoxemia defined by PaO2/FiO2\<100 or SpO2\<92% on HFNC settings: ≥ FiO2 80% or higher and O2 flow 40L/min * HFNC O2 delivery via tracheostomy * COVID-19 positive status (within 3 weeks prior to the enrollment) * Respiratory distress, defined by respiratory rate \> 24 breath per minute * Hemodynamic instability defined by the use of two or more vasopressor medications * Presence of nasal obstruction that may pose a risk for inadequate nebulizer delivery in the opinion of the investigator * Pulmonary comorbidities that, in the opinion of the investigator or clinical team, can pose a risk to subject safety or interfere with the subject's ability to complete the study procedures. * Moribund patient not expected to survive \>24 hours * Inability to obtain informed consent from patient * Respiratory therapists who are unwilling to participate.