Vásquez Hoyos, PabloVilla Rosero, Yinna M.Jaramillo-Bustamante, Juan C.Gómez Lund, OscarCarvajal, CristóbalDíaz, FrancoGonzález-Dambrauskas, SebastiánCaporal, PaulaJabornisky, RobertoSerra, AlbertoMonteverde-Fernandez, Nicolás2026-09-042026-09-042026-08-26Respiratory Care(2026) pp. 1-60020-1324https://hdl.handle.net/20.500.12254/7727Background: 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-driven HFNC liberation strategy and time to successful liberation from high-flow support in children with acute respiratory failure. 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). 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-Meier curves and multivariable Cox regression were used; gamma log-link models were used for sensitivity analyses, including a prespecified bronchiolitis subgroup. Results: We included 1,086 PICU admissions, 627 before and 459 after implementation. Median HFNC 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 HFNC liberation after implementation (log-rank P < .01). Implementation was associated with earlier liberation in adjusted Cox regression (hazard ratio 1.17, 95% CI 1.03-1.34, P = .02). PICU stay decreased from 4.7 days (IQR 3.2-6.9) to 4.0 days (IQR 2.9-5.8, P < .01). In bronchiolitis, implementation was associated with an 18.2% relative reduction in HFNC duration (95% CI 7.7-27.5%, P < .01). Conclusions: In a high-altitude PICU, a respiratory therapist-driven 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 settingsenAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)high-flow nasal cannulaliberationpediatricspediatric intensive carerespiratory failurehigh altitudeoxygen therapyrespiratory therapist–driven protocolArticlehttps://orcid.org/0000-0003-4763-074Xhttps://doi.org/10.1177/19433654261472965