Protocolized Weaning of High-Flow Nasal Cannula in Adult Patients

Inclusion Criteria: * Adult patients ≥ 18 years * Receiving HFNC for ≥12 hours * Receiving HFNC to treat acute hypoxemic respiratory failure, defined as requirement of FIO2 ≥ 0.5 to maintain SpO2 at 90-97% and Evidence of increased work of breathing at initiation (e.g., tachypnea with respiratory rate \> 20-25/min, or accessory muscle use), including: * Patients using HFNC to avoid intubation * Post-extubated patients who develop acute hypoxemic respiratory failure, regardless of respiratory support device prior to HFNC use. * The bedside clinical team determines that HFNC weaning is clinically appropriate * Demonstrates clinical stability, defined as: * Respiratory rate ≤ 25 breaths per minute without use of accessory respiratory muscles * SpO₂ \> 90% on HFNC * HFNC FiO₂ ≤ 0.80 Exclusion Criteria: * • Planned procedures requiring intubation * Hypercapnia (PaCO2 ≥ 45 mmHg) * Receiving extracorporeal membrane oxygenation (ECMO) * Receiving continuous aerosol therapy via HFNC (e.g., inhaled nitric oxide \[iNO\], epoprostenol, or continuous albuterol) * Receiving chronic home use of HFNC, CPAP, or noninvasive ventilation therapy to treat chronic respiratory failure * Receiving HFNC as preventative post-extubation therapy, defined as HFNC use immediately after extubation for less than 48 hr in the absence of clinical signs of respiratory failure.