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Neural respiratory drive predicts long-term outcome following admission for exacerbation of COPD: a post hoc analysis
  1. Maxime Patout1,2,
  2. Leonor Meira3,4,
  3. Rebecca D’Cruz5,6,
  4. Elodie Lhuillier1,2,
  5. Georgios Kaltsakas1,
  6. Gill Arbane1,3,
  7. Eui-Sik Suh1,7,
  8. Nicholas Hart1,7,
  9. Patrick Brian Murphy1,7
  1. 1 Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King’s College, London, UK
  2. 2 Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, Normandie Univ, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Rouen, France
  3. 3 Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  4. 4 Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
  5. 5 Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King’s College, London, UK
  6. 6 National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College, London, UK
  7. 7 Centre for Human, Aerospace and Physiological Sciences, King"s College, London, UK
  1. Correspondence to Dr Maxime Patout, Service de Pneumologie, oncologie thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen, France; maxime.patout{at}chu-rouen.fr

Abstract

Neural respiratory drive (NRD), as reflected by change in parasternal muscle electromyogram (EMGpara), predicts clinical deterioration and safe discharge in patients admitted to hospital with an acute exacerbation of COPD (AECOPD). The clinical utility of NRD to predict the long-term outcome of patients following hospital admission with an AECOPD is unknown. We undertook a post hoc analysis of a previously published prospective observational cohort study measuring NRD in 120 patients with AECOPD. Sixty-nine (57.5%) patients died during follow-up (median 3.6 years). Respiratory failure was the most common cause of death (n=29; 42%). In multivariate analysis, factors independently associated with an increased mortality included NRD (HR 2.14, 95% CI 1.29 to 3.54, p=0.003), age (HR 2.03, 95% CI 1.23 to 3.34, p=0.006), PaCO2 at admission (HR 1.83, 95% CI 1.06 to 3.06, p=0.022) and long-term oxygen use (HR 2.98, 95% CI 1.47 to 6.03, p=0.002). NRD at hospital discharge could be measured in order to assess efficacy of interventions targeted to optimise COPD and reduce mortality following an AECOPD.

Original clinicaltrial.gov number: NCT01361451

  • copd exacerbations
  • respiratory muscles
  • respiratory measurement

https://doi.org/10.1136/thoraxjnl-2018-212074

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    Footnotes

    • NH and PBM are joint senior authors.

    • Contributors MP, ESS, NH and PBM contributed to the conception of the work, analysis, interpretation of data and drafting of the work. LM, RB, GA, EL, GK, NH and PBM critically revised the draft. All authors contributed to the acquisition of data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MP reports grants from B&D Electromedical, during the conduct of the study; personal fees from Resmed and Philips-Respironivd, grants and non-financial support from Fisher & Paykel, non-financial support from MSD, non-financial support from Asten, grants from ADIR Association, outside the submitted work. EL reports personal fees and non-financial support from ASTEN, outside the submitted work. GK, RD, LM and GA have nothing to disclose. E-SS Suh reports grants from Philips Research, outside the submitted work. NH Pulmonary Research Advisory Board for Philips and the funds for this is given to Guy’s and St Thomas’ NHS Foundation Trust. My research group has received unrestricted grants (managed by Guy’s and St Thomas’ Foundation Trust) from Philips-Respironics, Philips, Resmed, Fisher-Paykel and B&D Electromedical. Philips and Philips-Respironics are contributing to the development of the MYOTRACE technology. PBM reports grants and personal fees from Philips-Respironics, grants and personal fees from Resmed, grants and personal fees from B&D electromedical, outside the submitted work.

    • Patient consent for publication Not required.

    • Ethics approval The original study was approved by the London-Bentham Research Ethics Committee. Post hoc analysis of the original study data was approved by Guy’s & St Thomas’ Research Ethics Committee (16/70/1773).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement There are no additional unpublished data from the study.

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