Lamb KD, et al. - Whether protocolized use of high-flow nasal cannula (HFNC) decreases unplanned intubation and adverse outcomes in an ICU population, was investigated herein. Cohort 1 received mechanical ventilation for ≥ 24 h and was extubated directly to HFNC following strict protocol criteria. Cohort 2 were placed on HFNC when oxygen requirements escalated (>4 L/min). As a result of extubation to HFNC in Cohort 1, a significant decrease in pulmonary infections and bronchodilator therapy was noted, with no reduction in length of stay or rates of failed extubation. In Cohort 2, the early and per protocol use of HFNC resulted in reduced hospital lengths of stay and more quick initiation of HFNC when the need for respiratory support escalated.