Abrupt versus gradual HFNC discontinuation in children: Shorter HFNC duration without increased weaning failure

High-flow nasal cannula (HFNC) therapy is widely used in pediatric acute respiratory distress, but evidence-based weaning protocols remain limited, and prolonged use may increase resource utilization. This study compared gradual versus abrupt HFNC weaning strategies and evaluate their clinical outcomes in children.

This prospective observational study was conducted between September 2025 and February 2026 in an academic pediatric emergency department. Patients receiving HFNC who met predefined clinical improvement criteria [FiO₂ ≤ 30%, S/F ratio > 270, and Pediatric Early Warning Score < 3] were enrolled. HFNC discontinuation strategy was determined by treating physicians according to routine clinical practice. Patients underwent either abrupt discontinuation or gradual flow reduction. The primary outcome was weaning success, defined as no HFNC re-initiation within 48 h. Secondary outcomes included HFNC duration and length of hospital stay (LOS).

Eighty-seven patients were included (63.2% male), with a median age of 10 months (range 4-32). The leading diagnoses were bronchopneumonia (60.9%) and lower airway obstruction (29.9%). HFNC was discontinued abruptly in 43 patients and gradually in 44 patients. Baseline characteristics were similar between groups. Weaning failure occurred in two patients in each group. Among successfully weaned patients, HFNC duration was significantly shorter with abrupt discontinuation [59 h (IQR 44-92) vs. 87 h (IQR 61-110), p = 0.012], whereas LOS did not differ significantly (p = 0.065).

Abrupt HFNC discontinuation was associated with shorter HFNC duration by approximately 32% without increasing weaning failure. This simplified approach may improve device availability and patient flow in high-demand emergency settings.