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

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Eui-Sik Suh, Swapna Mandal, Rachel Harding, Michelle Ramsay, Meera Kamalanathan, Katherine Henderson, Kevin O'Kane, Abdel Douiri, Nicholas S Hopkinson, Michael I Polkey, Gerrard Rafferty, Patrick B Murphy, John Moxham, Nicholas Hart

Original languageEnglish
Pages (from-to)1123-1130
Number of pages8
JournalThorax
Volume70
Issue number12
DOIs
StatePublished - 20 Jul 2015

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Abstract

RATIONALE: Hospitalised patients with acute exacerbation of COPD may deteriorate despite treatment, with early readmission being common.

OBJECTIVES: To 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.

METHODS: Patients 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 RESULTS: 120 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<0.001) and ΔIC (r=-0.44, p<0.001). ΔEMGpara%max predicted 14-day readmission (OR 1.13, 95% 1.03 to 1.23) in the whole cohort and 28-day readmission in patients under 85 years (OR 1.09, 95% CI 1.01 to 1.18). Age (OR 1.08, 95% CI 1.03 to 1.14) and 12-month admission frequency (OR 1.29, 1.01 to 1.66), also predicted 28-day readmission in the whole cohort.

CONCLUSIONS: Measurement of neural respiratory drive by EMGpara represents a novel physiological biomarker that may be helpful in detecting inpatient clinical deterioration and identifying the risk of early readmission among patients with exacerbations of COPD.

TRIAL REGISTRATION: NCT01361451.

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