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S82 CLINICAL USEFULNESS OF MEASURING NEURAL RESPIRATORY DRIVE FOR IDENTIFICATION OF DETERIORATION IN ACUTE EXACERBATIONS OF COPD
1P. Murphy, 2A. Kumar, 3C. Reilly, 3C. Jolley, 1K. Brignall, 4M. Polkey, 3J. Moxham, 5N. Hart. 1Lane Fox Respiratory Unit, Guy’s & St Thomas’ NHS Foundation Trust, London, UK, 2King’s College London, London, UK, 3Thoracic Medicine, King’s College Hospital, London, UK, 4Sleep & Ventilation Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK, 5Guy’s & St Thomas’ NHS Foundation Trust and Kings College London NIHR Biomedical Research Centre, London, UK
Introduction Early discharge schemes and transfer of acute care into the community setting are strategic objectives for the National Health Service (NHS), with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) identified as a key area. The ability to predict accurately response to treatment and early detection of clinical deterioration are therefore essential. We hypothesised that neural respiratory drive (NRD), as represented by parasternal muscle electromyography (EMGpara), could be used as a novel clinical tool to identify clinical change in AECOPD.
Method Emergency admissions to the acute medicine ward with AECOPD were enrolled within 24 h of admission. Repeated measures of EMGpara were performed during their hospital admission and correlated with clinical course as assessed by the supervising clinician, blinded to the EMGpara data. EMGpara was normalised to EMGpara%max obtained during a maximal sniff manoeuvre performed at the time of readings, and data were analysed off-line as peak root mean squared per breath1 to produce an EMGpara%max.
Results 25 patients (27% male), mean age 74 (8.5) years and forced expiratory volume in 1 s (FEV1) 0.57 (0.29) litres had baseline data recorded. All patients were able to tolerate EMGpara testing on study days, in contrast to 30% of patient unable or unwilling to complete FEV1 …