In their recent article, “Stepwise Liberation from High-Flow Nasal Cannula in Acute Respiratory Failure,” published in CHEST, the authors highlight that high-flow nasal cannula (HFNC) has become a first-line therapy for patients with acute respiratory failure. They note that despite widespread use—especially since the COVID-19 pandemic—high-quality evidence guiding HFNC discontinuation remains scarce. Decisions regarding when and how to reduce flow rate, FiO₂, or both, are often left to clinicians’ discretion in the absence of standardized protocols. Prolonged HFNC support when no longer needed may result in longer ICU and hospital stays, higher healthcare costs, and reduced availability of critical resources. To address this gap, the article proposes a standardized, physiology-based stepwise approach to HFNC liberation, analogous to spontaneous breathing trials in mechanically ventilated patients, with the aim of improving care efficiency and resource utilization in hospitalized patients with acute respiratory failure. High-Flow Nasal Cannula Liberation - CHEST
