BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease have a significant negative impact on both patients and healthcare systems. Currently, there are no physiological biomarkers that effectively monitor clinical change or predict respiratory readmission. Acute exacerbations impose a change in the respiratory muscle load-capacity-drive relationship. It was hypothesised that lack of a fall in neural respiratory drive would identify patients at risk of treatment failure and early hospital readmission. METHODS: An observational study was performed at two UK teaching hospitals. Routine clinical physiological parameters and neural respiratory drive index (NRDI), calculated as the product of second intercostal space parasternal electromyography (EMG) activity normalised to the peak EMG activity during a maximum inspiratory sniff manoeuvre and respiratory rate, were recorded daily from admission to discharge. RESULTS: 30 acutely unwell patients of mean (SD) age 72 (10) years, forced expiratory volume in 1 s 0.60 (1.65) l, NRDI 455 (263) AU and median length of stay 6 days were studied. Changes in NRDI correlated with changes in Borg score (r=+0.60; p<0.001), discriminated between patients deemed to have clinically improved rather than deteriorated (mean difference 339 AU; 95% CI 234 to 444; p<0.001) and identified those patients readmitted within 14 days (mean difference 203 AU; 95% CI 39 to 366; p=0.017). CONCLUSIONS: NRDI is a feasible clinical physiological parameter in patients with an acute exacerbation of chronic obstructive pulmonary disease and can provide useful information on treatment response and risk of readmission.
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease have a significant negative impact on both patients and healthcare systems. Currently, there are no physiological biomarkers that effectively monitor clinical change or predict respiratory readmission. Acute exacerbations impose a change in the respiratory muscle load-capacity-drive relationship. It was hypothesised that lack of a fall in neural respiratory drive would identify patients at risk of treatment failure and early hospital readmission. METHODS: An observational study was performed at two UK teaching hospitals. Routine clinical physiological parameters and neural respiratory drive index (NRDI), calculated as the product of second intercostal space parasternal electromyography (EMG) activity normalised to the peak EMG activity during a maximum inspiratory sniff manoeuvre and respiratory rate, were recorded daily from admission to discharge. RESULTS: 30 acutely unwell patients of mean (SD) age 72 (10) years, forced expiratory volume in 1 s 0.60 (1.65) l, NRDI 455 (263) AU and median length of stay 6 days were studied. Changes in NRDI correlated with changes in Borg score (r=+0.60; p<0.001), discriminated between patients deemed to have clinically improved rather than deteriorated (mean difference 339 AU; 95% CI 234 to 444; p<0.001) and identified those patients readmitted within 14 days (mean difference 203 AU; 95% CI 39 to 366; p=0.017). CONCLUSIONS: NRDI is a feasible clinical physiological parameter in patients with an acute exacerbation of chronic obstructive pulmonary disease and can provide useful information on treatment response and risk of readmission.
Authors: Matthieu Schmidt; Félix Kindler; Stewart B Gottfried; Mathieu Raux; Francois Hug; Thomas Similowski; Alexandre Demoule Journal: Intensive Care Med Date: 2013-04-11 Impact factor: 17.440
Authors: Matthieu Schmidt; Robert B Banzett; Mathieu Raux; Capucine Morélot-Panzini; Laurence Dangers; Thomas Similowski; Alexandre Demoule Journal: Intensive Care Med Date: 2013-10-17 Impact factor: 17.440
Authors: Victoria MacBean; Caroline J Jolley; Timothy G Sutton; Akash Deep; Anne Greenough; John Moxham; Gerrard F Rafferty Journal: Pediatr Res Date: 2016-04-13 Impact factor: 3.756
Authors: Zarrin F Shaikh; Julia L Kelly; Dinesh Shrikrishna; Manuel de Villa; Michael J Mullen; Nicholas S Hopkinson; Mary J Morrell; Michael I Polkey Journal: Am J Respir Crit Care Med Date: 2014-03-01 Impact factor: 21.405
Authors: Patrick B Murphy; Kate Brignall; John Moxham; Michael I Polkey; A Craig Davidson; Nicholas Hart Journal: Int J Chron Obstruct Pulmon Dis Date: 2012-12-11