RT Journal Article
SR Electronic
T1 Neural respiratory drive (NRD) measured by parasternal electromyography predicts clinical deterioration and early readmission in patients with acute exacerbation of COPD (AECOPD)
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 4434
VO 44
IS Suppl 58
A1 Eui-Sik Suh
A1 Swanpa Mandal
A1 Rachel Harding
A1 Michelle Ramsay
A1 Meera Kamalanathan
A1 Katherine Henderson
A1 Abdel Douiri
A1 Gerrard Rafferty
A1 Patrick B. Murphy
A1 John Moxham
A1 Nicholas Hart
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/4434.abstract
AB Background Second intercostal space parasternal muscle electromyography (EMGpara) can be used as a physiological biomarker of NRD in patients with severe AECOPD (Murphy et al, Thorax 2011). We hypothesised that NRD would predict patient- and physician-defined deterioration, and early readmission in these patients.Methods Spirometry, inspiratory capacity (IC), EMGpara, medical early warning score (MEWS) and Borg dyspnoea scale were recorded daily in patients with AECOPD admitted to a UK hospital.. Physician-defined deterioration and early readmissions were noted.Results 120 patients were enrolled (age 70±9years, BMI 25·3±7·2kg/m2 and FEV1 31±11% predicted). Admission-to-discharge changes (Δ) in the normalised value of EMGpara (EMGpara%max) were inversely correlated with ΔFEV1 (r=-0·38, p<0·001) and ΔIC (r=-0·44, p<0·001). ΔEMGpara%max and ΔMEWS between consecutive recordings predicted worsening of dyspnoea, defined as ≥1point rise in Borg scale. Only ΔEMGpara%max predicted physician-defined deterioration.Age (OR 1·08, p=0·004) and 12-month admission frequency (OR 1·29, p=0·04) predicted 28-day readmission. ΔEMGpara%max (OR 1·09, p=0·02) predicted 28-day readmission in patients under 85 years. ΔEMGpara%max (OR 1·13, p=0·007) and changes in oxygen saturation (OR 1·21, p=0·02) predicted 14-day readmission.Conclusion NRD was a biomarker of changes in the physiological load on the respiratory system during AECOPD; it detected clinical deterioration in hospital suggesting a role as a monitoring tool. NRD also predicted early readmission, so it could be used to optimise discharge planning in COPD patients.