Neural respiratory drive predicts clinical deterioration and safe discharge in exacerbations of COPD

RationaleHospitalised patients with acute exacerbation of COPD may deteriorate despite treatment, with early readmission being common.ObjectivesTo investigate whether neural respiratory drive, measured using second intercostal space parasternal muscle electromyography (EMGpara), would identify worse...

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Bibliographic Details
Published in:	Thorax 2015-12, Vol.70 (12), p.1123-1130
Main Authors:	Suh, Eui-Sik, Mandal, Swapna, Harding, Rachel, Ramsay, Michelle, Kamalanathan, Meera, Henderson, Katherine, O'Kane, Kevin, Douiri, Abdel, Hopkinson, Nicholas S, Polkey, Michael I, Rafferty, Gerrard, Murphy, Patrick B, Moxham, John, Hart, Nicholas
Format:	Article
Language:	eng
Subjects:	Aged Biomarkers Chronic Obstructive Pulmonary Disease Cohort analysis Disease Progression Dyspnea Electromyography Emergency medical care Female Forced Expiratory Volume Humans Logistic Models Male Middle Aged Mortality Patients Physiology Pulmonary Disease, Chronic Obstructive - physiopathology ROC Curve Spirometry Ventilators
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Summary:	RationaleHospitalised patients with acute exacerbation of COPD may deteriorate despite treatment, with early readmission being common.ObjectivesTo investigate whether neural respiratory drive, measured using second intercostal space parasternal muscle electromyography (EMGpara), would identify worsening dyspnoea and physician-defined inpatient clinical deterioration, and predict early readmission.MethodsPatients admitted to a single-site university hospital with exacerbation of COPD were enrolled. Spirometry, inspiratory capacity (IC), EMGpara, routine physiological parameters, modified early warning score (MEWS), modified Borg scale for dyspnoea and physician-defined episodes of deterioration were recorded daily until discharge. Readmissions at 14 and 28 days post discharge were recorded.Measurements and main results120 patients were recruited (age 70±9 years, forced expiratory volume in 1 s (FEV1) of 30.5±11.2%). Worsening dyspnoea, defined as at least one-point increase in Borg scale, was associated with increases in EMGpara%max and MEWS, whereas an increase in EMGpara%max alone was associated with physician-defined inpatient clinical deterioration. Admission-to-discharge change (Δ) in the normalised value of EMGpara (ΔEMGpara%max) was inversely correlated with ΔFEV1 (r=−0.38, p
ISSN:	0040-6376 1468-3296