Stripoli T, et al. - In this single-center, unblinded, cross-over study on 14 patients, researchers compared neuro-ventilatory drive, work of breathing, respiratory rate (RR) and gas exchange, in relation to high-flow oxygen therapy applied to the tracheostomy cannula (T-HF) vs conventional low-flow oxygen therapy (conventional O₂) in a mixed population of tracheostomized patients at high risk of weaning failure. Two 1-h periods of T-HF (T-HF1 and T-HF2) alternated with 1 h of conventional O₂ was received by each patient following disconnection from the ventilator. An arterial O₂ saturation target of 94–98% (88–92% in chronic obstructive pulmonary disease patients) was achieved by titrating inspiratory oxygen fraction. According to findings, T-HF vs conventional O₂ did not result in an improved neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange after disconnection from the ventilator in tracheostomized patients at high risk of weaning failure from mechanical ventilation. Possibly, physiological impacts of high-flow therapy through tracheostomy substantially differ from nasal high flow.