{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:39:51Z","timestamp":1787323191967,"version":"build-2736575974"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>High-flow nasal cannula (HFNC) liberation strategies in pediatric intensive care often transition patients directly from HFNC to room air. At high altitude, oxygen requirements may persist after flow-dependent respiratory support is no longer needed. We evaluated the association between a protocolized, respiratory therapist\u2013driven HFNC liberation strategy and time to successful liberation from high-flow support in children with acute respiratory failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using prospectively collected LARed Network registry data from a tertiary PICU in Bogot\u00e1, Colombia (2,600 m altitude). In September 2022, the unit implemented an HFNC liberation strategy designed to separate persistent oxygen requirement from ongoing need for high-flow support. The primary analysis included the first HFNC episode per PICU admission from March 2018 to March 2025. The primary outcome was time to successful HFNC liberation. Kaplan\u2013Meier curves and multivariable Cox regression were used; gamma log-link models were used for sensitivity analyses, including a prespecified bronchiolitis subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We included 1,086 PICU admissions,\u00a0627 before and 459 after implementation. Median HFNC duration decreased from 59.8 h (interquartile ranges [IQR] 34.7\u201391.4) to 53.1 h (IQR 32.3\u201380.5,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01). Kaplan\u2013Meier analysis showed earlier HFNC liberation after implementation (log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01). Implementation was associated with earlier liberation in adjusted Cox regression (hazard ratio 1.17, 95% CI 1.03\u20131.34,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02). PICU stay decreased from 4.7\u2009days (IQR 3.2\u20136.9) to 4.0\u2009days (IQR 2.9\u20135.8,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01). In bronchiolitis, implementation was associated with an 18.2% relative reduction in HFNC duration (95% CI 7.7\u201327.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In a high-altitude PICU, a respiratory therapist\u2013driven HFNC liberation strategy was associated with earlier liberation from high-flow support. A strategy that preserves oxygen delivery while testing tolerance of minimal flow may be useful in high-altitude settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654261472965","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:36:18Z","timestamp":1787135778000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Respiratory Therapist\u2013Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4892-5032","authenticated-orcid":false,"given":"Pablo","family":"V\u00e1squez Hoyos","sequence":"first","affiliation":[{"name":"Drs. V\u00e1squez Hoyos and Villa Rosero is affiliated with Department of Pediatrics, Universidad Nacional de Colombia, Bogot\u00e1, Colombia."},{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. V\u00e1squez Hoyos is affiliated with Department of Pediatrics, Sociedad de Cirug\u00eda de Bogot\u00e1\u2014Hospital de San Jos\u00e9, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinna M.","family":"Villa Rosero","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos and Villa Rosero is affiliated with Department of Pediatrics, Universidad Nacional de Colombia, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Jaramillo-Bustamante","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. Jaramillo-Bustamante is affiliated with Department of Pediatrics, Hospital General de Medell\u00edn Luz Castro de Guti\u00e9rrez E.S.E., Medell\u00edn, Colombia."},{"name":"Dr. Jaramillo-Bustamante is affiliated with Hospital Pablo Tob\u00f3n Uribe, Medell\u00edn, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar G\u00f3mez","family":"Lund","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. Lund is affiliated with Unidad de Cuidados Intensivos Pedi\u00e1tricos, Sanatorio Altos de Salta, Salta, Argentina."},{"name":"Dr. Lund is affiliated with Facultad de Medicina, Universidad Nacional de Salta, Salta, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristobal","family":"Carvajal","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Drs. Carvajal and D\u00edaz is affiliated with Unidad de Investigaci\u00f3n y Epidemiolog\u00eda Cl\u00ednica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Drs. Carvajal and D\u00edaz is affiliated with Unidad de Investigaci\u00f3n y Epidemiolog\u00eda Cl\u00ednica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile."},{"name":"Dr. D\u00edaz is affiliated with Hospital Cl\u00ednico San Borja Arriar\u00e1n, Unidad de Paciente Cr\u00edtico Pedi\u00e1trico, Santiago, Chile."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Gonz\u00e1lez-Dambrauskas","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. Gonz\u00e1lez-Dambrauskas and Serra is affiliated with Departamento de Pediatr\u00eda y Unidad de Cuidados Intensivos de Ni\u00f1os, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay."},{"name":"Dr. Gonz\u00e1lez-Dambrauskas is affiliated with Facultad de Medicina, Universidad de la Rep\u00fablica, Montevideo, Uruguay."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Caporal","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. Caporal is affiliated with Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Jabornisky","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. Jabornisky is affiliated with Hospital Juan Pablo II, Corrientes, Argentina."},{"name":"Dr. Jabornisky is affiliated with Hospital Regional Olga Stucky de Rizzi, Reconquista, Argentina."},{"name":"Dr. Jabornisky is affiliated with Department of Pediatrics, Universidad Nacional del Nordeste, Corrientes, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Serra","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. Gonz\u00e1lez-Dambrauskas and Serra is affiliated with Departamento de Pediatr\u00eda y Unidad de Cuidados Intensivos de Ni\u00f1os, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Monteverde-Fernandez","sequence":"additional","affiliation":[{"name":"Drs. V\u00e1squez Hoyos, Jaramillo-Bustamante, Lund, Carvajal, D\u00edaz, Gonz\u00e1lez-Dambrauskas, Caporal, Jabornisky, Serra and Monteverde-Fernandez is affiliated with Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed Network), Uruguay."},{"name":"Dr. Monteverde-Fernandez is affiliated with Pediatric Intensive Care, M\u00e9dica Uruguaya, Montevideo, Uruguay."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.04.007"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-016-0278-4"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.3345\/kjp.2019.00626"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1714855"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2020-000844"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31827122a9"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002258"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08284"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.26606"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003136"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/ped.2021.0229"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003183"},{"key":"e_1_3_2_14_1","first-page":"8","article-title":"High-flow nasal cannula weaning protocols in children: a narrative review","volume":"4","author":"G\u00f3mez MJ","year":"2025","unstructured":"13.G\u00f3mez MJ, , P\u00e9rez J, and Telechea H. High-flow nasal cannula weaning protocols in children: a narrative review. Emerg Pediatr 2025; 4: 8\u201312.","journal-title":"Emerg Pediatr"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201207-1323CI"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1201\/b13633"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2008.141838"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pcc.0001084572.70211.32"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1972.tb00899.x"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/81.3.515"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261472965","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19433654261472965","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261472965","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:47:11Z","timestamp":1787320031000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19433654261472965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":22,"alternative-id":["10.1177\/19433654261472965"],"URL":"https:\/\/doi.org\/10.1177\/19433654261472965","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"article-number":"19433654261472965"}}