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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

Weaning from mechanical ventilation is an ill-defined process. The 2007 International Consensus Conference (ICC) weaning definition is difficult to apply as it uses spontaneous breathing trials (SBT) which are not universally used and excludes tracheostomised patients and those who fail to wean or die. In this prospective, multinational observational study, Beduneau et al propose a weaning classification for utilisation in daily practice for all mechanically ventilated patients ( Am J Respir Crit Care Med 2017;195:772–83). 2709 intubated patients from 36 European intensive care units (ICUs) were observed until ICU discharge or day 60. The authors propose a classification based on weaning duration from first separation attempt (extubation or SBT in intubated patients or ≥24 hours spontaneous ventilation in tracheostomised patients). Group ‘no weaning’ (24%) had no separation attempt; group 1 (57%) weaned in 1 and