P36 An Advanced Physiological Monitoring Tool To Detect Treatment Failure In Hospitalised Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease (AECOPD)

Background Acute exacerbations of COPD are associated with significant mortality and morbidity. Hospitalised patients with AECOPD often deteriorate symptomatically despite treatment. We have developed 2nd intercostal space parasternal EMG (EMGpara) as a measure of neural respiratory drive (NRD), wit...

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Veröffentlicht in:Thorax 2012-12, Vol.67 (Suppl 2), p.A78-A79
Hauptverfasser: Suh, ES, Mandal, S, Ramsay, MC, Harding, R, Thompson, A, Moxham, J, Hart, N
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container_end_page A79
container_issue Suppl 2
container_start_page A78
container_title Thorax
container_volume 67
creator Suh, ES
Mandal, S
Ramsay, MC
Harding, R
Thompson, A
Moxham, J
Hart, N
description Background Acute exacerbations of COPD are associated with significant mortality and morbidity. Hospitalised patients with AECOPD often deteriorate symptomatically despite treatment. We have developed 2nd intercostal space parasternal EMG (EMGpara) as a measure of neural respiratory drive (NRD), with the aim of detecting clinical change in such patients. We hypothesised that change in NRD would be able to detect treatment failure in an unselected cohort of AECOPD patients. Methods Patients with AECOPD were recruited at a central London teaching hospital within 12 hours of admission. Patients underwent EMGpara, spirometry and measurement of inspiratory capacity at least daily until medically fit for discharge. Modified Borg scale was recorded with each EMGpara acquisition. We assessed improvement and deterioration by two measures: 1) the responsible medical team was asked to report any deterioration or improvement in the patients’ condition during the course of admission (Leidy et al, AJRCCM 2011); and 2) 2-point changes in Borg score were recorded as representing significant deterioration or improvement in dyspnoea (Ries et al, COPD; 2005). Changes in EMGpara%max and neural respiratory drive index (ΔNRDI, where NRDI= EMGpara%max x respiratory rate) (Murphy et al, Thorax; 2011) during episodes of deterioration or improvement were analysed. Results 65 patients were recruited. At admission, age was 71±10 years, male 46.2%, FEV1%predicted 32±15% (n=34), body mass index (BMI) 25.6±7.7 kg/m2, length of hospital stay 4 (IQR 2–5.75) days, admission COPD assessment tool (CAT) score 29 (IQR 25–33). There were 66(83%) episodes of improvement and 14(17%) episodes of deterioration as defined by physician opinion. There was a difference in the change in EMGpara%max between episodes of improvement and deterioration (ΔEMGpara%max= –2.00% vs +4.99%, p=0.01; ΔNRDI= –53/min vs 117/min, p=0.02). There were 54(65%) episodes of improvement and 29(35%) episodes of deterioration as defined by a 2-point change on the Borg scale. Again there was a difference in neural drive measures between improvers and deteriorators (ΔEMGpara%max= –3.94% vs +2.72%, p=0.002; ΔNRDI= –108/min vs 74/min, p
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Hospitalised patients with AECOPD often deteriorate symptomatically despite treatment. We have developed 2nd intercostal space parasternal EMG (EMGpara) as a measure of neural respiratory drive (NRD), with the aim of detecting clinical change in such patients. We hypothesised that change in NRD would be able to detect treatment failure in an unselected cohort of AECOPD patients. Methods Patients with AECOPD were recruited at a central London teaching hospital within 12 hours of admission. Patients underwent EMGpara, spirometry and measurement of inspiratory capacity at least daily until medically fit for discharge. Modified Borg scale was recorded with each EMGpara acquisition. We assessed improvement and deterioration by two measures: 1) the responsible medical team was asked to report any deterioration or improvement in the patients’ condition during the course of admission (Leidy et al, AJRCCM 2011); and 2) 2-point changes in Borg score were recorded as representing significant deterioration or improvement in dyspnoea (Ries et al, COPD; 2005). Changes in EMGpara%max and neural respiratory drive index (ΔNRDI, where NRDI= EMGpara%max x respiratory rate) (Murphy et al, Thorax; 2011) during episodes of deterioration or improvement were analysed. Results 65 patients were recruited. At admission, age was 71±10 years, male 46.2%, FEV1%predicted 32±15% (n=34), body mass index (BMI) 25.6±7.7 kg/m2, length of hospital stay 4 (IQR 2–5.75) days, admission COPD assessment tool (CAT) score 29 (IQR 25–33). There were 66(83%) episodes of improvement and 14(17%) episodes of deterioration as defined by physician opinion. There was a difference in the change in EMGpara%max between episodes of improvement and deterioration (ΔEMGpara%max= –2.00% vs +4.99%, p=0.01; ΔNRDI= –53/min vs 117/min, p=0.02). There were 54(65%) episodes of improvement and 29(35%) episodes of deterioration as defined by a 2-point change on the Borg scale. Again there was a difference in neural drive measures between improvers and deteriorators (ΔEMGpara%max= –3.94% vs +2.72%, p=0.002; ΔNRDI= –108/min vs 74/min, p&lt;0.001) (Figure 1). Abstract P36 Figure 1 Conclusions Neural respiratory drive, as measured by parasternal muscle EMG, is effective in the detection of improvement and deterioration during AECOPD, and demonstrates potential as a physiological biomarker to monitor clinical change.</description><identifier>ISSN: 0040-6376</identifier><identifier>EISSN: 1468-3296</identifier><identifier>DOI: 10.1136/thoraxjnl-2012-202678.177</identifier><identifier>CODEN: THORA7</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Thoracic Society</publisher><ispartof>Thorax, 2012-12, Vol.67 (Suppl 2), p.A78-A79</ispartof><rights>2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2012 (c) 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>114,314,780,784,3196,27924,27925</link.rule.ids></links><search><creatorcontrib>Suh, ES</creatorcontrib><creatorcontrib>Mandal, S</creatorcontrib><creatorcontrib>Ramsay, MC</creatorcontrib><creatorcontrib>Harding, R</creatorcontrib><creatorcontrib>Thompson, A</creatorcontrib><creatorcontrib>Moxham, J</creatorcontrib><creatorcontrib>Hart, N</creatorcontrib><title>P36 An Advanced Physiological Monitoring Tool To Detect Treatment Failure In Hospitalised Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease (AECOPD)</title><title>Thorax</title><addtitle>Thorax</addtitle><description>Background Acute exacerbations of COPD are associated with significant mortality and morbidity. Hospitalised patients with AECOPD often deteriorate symptomatically despite treatment. We have developed 2nd intercostal space parasternal EMG (EMGpara) as a measure of neural respiratory drive (NRD), with the aim of detecting clinical change in such patients. We hypothesised that change in NRD would be able to detect treatment failure in an unselected cohort of AECOPD patients. Methods Patients with AECOPD were recruited at a central London teaching hospital within 12 hours of admission. Patients underwent EMGpara, spirometry and measurement of inspiratory capacity at least daily until medically fit for discharge. Modified Borg scale was recorded with each EMGpara acquisition. We assessed improvement and deterioration by two measures: 1) the responsible medical team was asked to report any deterioration or improvement in the patients’ condition during the course of admission (Leidy et al, AJRCCM 2011); and 2) 2-point changes in Borg score were recorded as representing significant deterioration or improvement in dyspnoea (Ries et al, COPD; 2005). Changes in EMGpara%max and neural respiratory drive index (ΔNRDI, where NRDI= EMGpara%max x respiratory rate) (Murphy et al, Thorax; 2011) during episodes of deterioration or improvement were analysed. Results 65 patients were recruited. At admission, age was 71±10 years, male 46.2%, FEV1%predicted 32±15% (n=34), body mass index (BMI) 25.6±7.7 kg/m2, length of hospital stay 4 (IQR 2–5.75) days, admission COPD assessment tool (CAT) score 29 (IQR 25–33). There were 66(83%) episodes of improvement and 14(17%) episodes of deterioration as defined by physician opinion. There was a difference in the change in EMGpara%max between episodes of improvement and deterioration (ΔEMGpara%max= –2.00% vs +4.99%, p=0.01; ΔNRDI= –53/min vs 117/min, p=0.02). There were 54(65%) episodes of improvement and 29(35%) episodes of deterioration as defined by a 2-point change on the Borg scale. Again there was a difference in neural drive measures between improvers and deteriorators (ΔEMGpara%max= –3.94% vs +2.72%, p=0.002; ΔNRDI= –108/min vs 74/min, p&lt;0.001) (Figure 1). Abstract P36 Figure 1 Conclusions Neural respiratory drive, as measured by parasternal muscle EMG, is effective in the detection of improvement and deterioration during AECOPD, and demonstrates potential as a physiological biomarker to monitor clinical change.</description><issn>0040-6376</issn><issn>1468-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqVUc2O0zAQjhBIlIV3MOIChywZO7WTY5R22ZWWbYVKOVq242xdUrvYzqp748Lr8FA8Ca6C9s5l5jDfz-j7suwtFJcAhH6MO-fFaW-HHBeA08CUVZfA2LNsBiWtcoJr-jybFUVZ5JQw-jJ7FcK-KIoKgM2y32tC__z81VjUdA_CKt2h9e4xGDe4e6PEgD47a6Lzxt6jjXNDGmiho1YRbbwW8aBtRFfCDKPX6MaiaxeOJorBhLOSiCbdA_pm4g41aowaLU9CaS_TxVm06lG788lBoZUM0Y8qmgeN1uNwcFb4R7RIOiJo9L5Ztqv14sPr7EUvhqDf_NsX2der5aa9zm9Xn27a5jaXGDDLMWYKYN4rpglLCZQpFkmEpL2Sqi67WkipSyAdrSXrVYoFurKSc9LXNQFMyEX2btI9evdj1CHyvRu9TZYcWAUVUAp1QtUTSnkXgtc9P3pzSH9zKPi5Hv5UDz_Xw6d6kgRL3HzimhD16Yko_HdOGWFzfrdt-Zfttrxb4DlvE76c8PKw_w-bv25kqIg</recordid><startdate>201212</startdate><enddate>201212</enddate><creator>Suh, ES</creator><creator>Mandal, S</creator><creator>Ramsay, MC</creator><creator>Harding, R</creator><creator>Thompson, A</creator><creator>Moxham, J</creator><creator>Hart, N</creator><general>BMJ Publishing Group Ltd and British Thoracic Society</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>201212</creationdate><title>P36 An Advanced Physiological Monitoring Tool To Detect Treatment Failure In Hospitalised Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease (AECOPD)</title><author>Suh, ES ; Mandal, S ; Ramsay, MC ; Harding, R ; Thompson, A ; Moxham, J ; Hart, N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b2127-227c115fc7e373294026b3ab6fcbc94d9abbe413d69b7fc3761d48b53f9931233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suh, ES</creatorcontrib><creatorcontrib>Mandal, S</creatorcontrib><creatorcontrib>Ramsay, MC</creatorcontrib><creatorcontrib>Harding, R</creatorcontrib><creatorcontrib>Thompson, A</creatorcontrib><creatorcontrib>Moxham, J</creatorcontrib><creatorcontrib>Hart, N</creatorcontrib><collection>Istex</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Thorax</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suh, ES</au><au>Mandal, S</au><au>Ramsay, MC</au><au>Harding, R</au><au>Thompson, A</au><au>Moxham, J</au><au>Hart, N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>P36 An Advanced Physiological Monitoring Tool To Detect Treatment Failure In Hospitalised Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease (AECOPD)</atitle><jtitle>Thorax</jtitle><addtitle>Thorax</addtitle><date>2012-12</date><risdate>2012</risdate><volume>67</volume><issue>Suppl 2</issue><spage>A78</spage><epage>A79</epage><pages>A78-A79</pages><issn>0040-6376</issn><eissn>1468-3296</eissn><coden>THORA7</coden><abstract>Background Acute exacerbations of COPD are associated with significant mortality and morbidity. Hospitalised patients with AECOPD often deteriorate symptomatically despite treatment. We have developed 2nd intercostal space parasternal EMG (EMGpara) as a measure of neural respiratory drive (NRD), with the aim of detecting clinical change in such patients. We hypothesised that change in NRD would be able to detect treatment failure in an unselected cohort of AECOPD patients. Methods Patients with AECOPD were recruited at a central London teaching hospital within 12 hours of admission. Patients underwent EMGpara, spirometry and measurement of inspiratory capacity at least daily until medically fit for discharge. Modified Borg scale was recorded with each EMGpara acquisition. We assessed improvement and deterioration by two measures: 1) the responsible medical team was asked to report any deterioration or improvement in the patients’ condition during the course of admission (Leidy et al, AJRCCM 2011); and 2) 2-point changes in Borg score were recorded as representing significant deterioration or improvement in dyspnoea (Ries et al, COPD; 2005). Changes in EMGpara%max and neural respiratory drive index (ΔNRDI, where NRDI= EMGpara%max x respiratory rate) (Murphy et al, Thorax; 2011) during episodes of deterioration or improvement were analysed. Results 65 patients were recruited. At admission, age was 71±10 years, male 46.2%, FEV1%predicted 32±15% (n=34), body mass index (BMI) 25.6±7.7 kg/m2, length of hospital stay 4 (IQR 2–5.75) days, admission COPD assessment tool (CAT) score 29 (IQR 25–33). There were 66(83%) episodes of improvement and 14(17%) episodes of deterioration as defined by physician opinion. There was a difference in the change in EMGpara%max between episodes of improvement and deterioration (ΔEMGpara%max= –2.00% vs +4.99%, p=0.01; ΔNRDI= –53/min vs 117/min, p=0.02). There were 54(65%) episodes of improvement and 29(35%) episodes of deterioration as defined by a 2-point change on the Borg scale. Again there was a difference in neural drive measures between improvers and deteriorators (ΔEMGpara%max= –3.94% vs +2.72%, p=0.002; ΔNRDI= –108/min vs 74/min, p&lt;0.001) (Figure 1). Abstract P36 Figure 1 Conclusions Neural respiratory drive, as measured by parasternal muscle EMG, is effective in the detection of improvement and deterioration during AECOPD, and demonstrates potential as a physiological biomarker to monitor clinical change.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Thoracic Society</pub><doi>10.1136/thoraxjnl-2012-202678.177</doi><oa>free_for_read</oa></addata></record>
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title P36 An Advanced Physiological Monitoring Tool To Detect Treatment Failure In Hospitalised Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease (AECOPD)
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