Protocolized Weaning of High-Flow Nasal Cannula in Adult Patients

High‐flow nasal cannula (HFNC) therapy has become a standard treatment for acutehypoxemic respiratory failure. Although evidence supports its use for improvingoxygenation and reducing intubation risk, guidance on how to discontinue HFNC remainslimited. Current weaning practices are highly variable across institutions andclinicians. This variability may contribute to either premature discontinuation, leadingto respiratory deterioration, or prolonged therapy, which may delay ICU discharge andincrease healthcare utilization.This trial evaluates implementation of a standardized HFNC weaning protocol acrossmultiple hospitals using a stepped‐wedge cluster randomized design. The interventionfocuses on structured, progressive reduction of HFNC flow and fraction of inspired oxygen(FiO₂), with predefined criteria for discontinuation and re‐escalation of support.The stepped‐wedge approach allows sequential implementation of the protocol acrossparticipating hospitals while accounting for secular trends and inter‐site practicevariability. The study is designed to determine whether protocolized weaning improvesefficiency and clinical outcomes compared with usual care.Findings from this trial are intended to inform evidence‐based guidance for HFNCliberation strategies in adult patients with acute hypoxemic respiratory failure.