A Respiratory Therapist-Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude.

Cohort studyRespiratory care· Aug 2026

A Respiratory Therapist-Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude.

Pablo Vásquez Hoyos, Yinna M Villa Rosero, Juan C Jaramillo-Bustamante … Nicolas Monteverde-Fernandez

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Pediatric Critical & Emergency CareCohort studyTreatmentQ2IF 1.4

Respiratory therapist-driven protocol linked to earlier liberation from high-flow nasal cannula

A Respiratory Therapist-Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude.

Pablo Vásquez Hoyos … Nicolas Monteverde-Fernandez

Respiratory care · Aug 2026 · Q2 in General Medicine

Background

High-flow nasal cannula (high-flow nasal cannula) liberation strategies in pediatric intensive care often transition patients directly from high-flow nasal cannula to room air.

Methods

We conducted a retrospective cohort study using prospectively collected LARed Network registry data from a tertiary PICU in Bogotá, Colombia (2,600 m altitude).

Results

protocol group liberated from high-flow support sooner

HR 1.17 (95% CI 1.03 to 1.34)

null 1

1.03

1.34

CI excludes the null - significant

More results

Median high-flow nasal cannula duration decreased from 59.8 h (interquartile ranges [IQR] 34.7-91.4) to 53.1 h (IQR 32.3-80.5, P = .01).

Kaplan-Meier analysis showed earlier high-flow nasal cannula liberation after implementation (log-rank P < .01).

PICU stay decreased from 4.7 days (IQR 3.2-6.9) to 4.0 days (IQR 2.9-5.8, P < .01).

More results

In bronchiolitis, implementation was associated with an 18.2% relative reduction in high-flow nasal cannula duration (95% CI 7.7-27.5%, P < .01).

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Conclusion · 1 of 2

In a high-altitude PICU, a respiratory therapist-driven high-flow nasal cannula liberation strategy was associated with earlier liberation from high-flow support.

Conclusion · 2 of 2

A strategy that preserves oxygen delivery while testing tolerance of minimal flow may be useful in high-altitude settings.

A Respiratory Therapist-Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude.

A Respiratory Therapist-Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude.

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