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Published on: June 28, 2018
Multidisciplinary and stratified non-pharmacological airway clearance intervention to prevent stroke-associated
Yingchun Chen1, Lihong Huang2, Xi Huang2
1Department of Rehabilitation Medicine, Siping City Central People's Hospital, Siping, China.
Aims:
This study evaluated the effectiveness of multidisciplinary treatment combined with non-pharmacological airway clearance techniques in preventing stroke-associated pneumonia (SAP).
Methods:
A quasi-experimental study was conducted at Central People's Hospital of Siping City, China, from March to May 2024. A total of 160 stroke patients were enrolled and assigned to an intervention group (n = 80) or control group (n = 80). Group allocation was performed using a non-randomized sequential assignment approach based on the order of admission and ward availability. The intervention group received multidisciplinary care with stratified airway clearance: active cycle of breathing techniques (ACBT) for patients with preserved cooperation [National Institutes of Health Stroke Scale (NIHSS) ≤15, Glasgow Coma Scale (GCS) >8]and high-frequency chest wall oscillation (HFCWO) for those with impaired consciousness (NIHSS > 15, GCS ≤ 8). Controls received conventional care.
Results:
After adjusting for baseline age and GCS, the intervention group had a significantly lower incidence of SAP (34.2% vs. 68.1%; adjusted odds ratio [OR] = 0.001, 95% confidence interval [CI]: 6.3 × 10-5 -0.028, p < 0.001). There was no statistically significant difference in intubation rates between groups (27.6% vs. 31.9%, p = 0.566). Among SAP patients, clinical pulmonary infection scores (CPIS) were consistently lower in the intervention group (day 7 mean: 5.53 vs. 6.92, p < 0.001). Gas exchange improved, with lower PaCO2 (43.53 vs. 45.06 mmHg, p = 0.002) and higher PaO2 (95.38 vs. 90.92 mmHg, p = 0.002). As well as shorter intubation duration (10 vs. 16 days), cure time (8 vs. 11 days), and hospital stay (13.3 vs. 19.8 days) (all p < 0.001). whereas hospitalization costs did not differ significantly (17,716.6 vs. 17,079.5 yuan, = 0.539).
Conclusion:
Multidisciplinary care with stratified non-pharmacological airway clearance significantly reduced SAP incidence, lowered CPIS, improved PaCO2 and PaO2, and shortened intubation duration, cure days, and hospital stay. Although no statistically significant differences were found in intubation rate or hospitalization costs, these findings support the clinical value of individualized airway management in stroke patients.
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