Dyspnea is related to clinical outcomes in patients weaning from invasive mechanical ventilation with tracheostomy: a multicenter prospective study

Tracheostomized critically ill patients weaning from invasive mechanical ventilation (IMV) are at risk for dyspnea. This study aimed to assess the prevalence and severity of dyspnea during tracheostomized weaning, its impact on weaning outcomes, and its association with psychological outcome and health-related quality of life (HR-QoL) after Intensive Care unit (ICU)-discharge. A prospective observational study in tracheostomized patients weaning from mechanical ventilation was performed in 13 hospitals in the Netherlands. Main exclusion criteria were tracheostomy for airway obstruction and neuromuscular disease. Dyspnea was assessed daily during mechanical ventilation and weaning. The primary endpoint was the number of weaning days with dyspnea. Main secondary endpoints were dyspnea severity measured using a visual analog scale (D-VAS), weaning success, post-traumatic stress disorder (PTSD) related symptoms and HR-QoL evaluated using IES-R and EQ-5D questionnaires 90 days post- ICU, respectively. From April 2023 to June 2024, 156 patients were included; 130 (83%) were successfully weaned. The median weaning duration was 10 [8−15] days, with a median of 3 [2−6] days with dyspnea per patient. Dyspnea affected 58% of patients, with a median D-VAS score of 6 [5–7]. Dyspnea was associated with longer weaning duration and reduced weaning success (hazard ratio 0.37, P < 0.001). The number of days with dyspnea correlated significantly with IES-R (linear regression coefficient (β) 2.42; P = 0.02) and EQ-5D utility score (-0.025; P = 0.03). Dyspnea in tracheostomized critically ill patients is common during weaning and associated with prolonged weaning, reduced weaning success, increased PTSD-symptoms and decreased HR-QoL after ICU discharge.