Application of noninvasive ventilation with nasopharyngeal airway in stroke patients

Abstract

Objective To study the employment of noninvasive ventilation with nasopharyngeal airway in coma patients with cerebral stroke. Methods One hundred and fifty-five stroke patients treated with noninvasive ventilation admitted from May 2011 to May 2013 were studied. There were 88 male and 67 female, aged 30 - 95 years with mean age 73 years, The patients suffered from stroke with APACHEⅡscore 5 - 13 and Glasgow coma score 7 -13. There were 78 cases in the nasopharyngeal airway group, and 77 cases in oropharyngeal airway group as control. SBP, DBP, HR, SpO2 and PCO2 were observed in the two groups at the time of beginning of noninvasive ventilation with neither airway (T0), and after placement of either airway and noninvasive ventilation for 10 min (T10), 20min (T20), and 30 min (T30), respectively. The differences in rate of endotracheal intubation and the incidence of pulmonary infection were compared between the two groups. Results PaO2,SBP, PCO2 were improved after 30 minutes of noninvasive ventilation in the oropharyngeal airway group, and SBP DBP, HR decreased which were associated with improved respiration, less stress response, and then good blood circulation system. The better improvement of respiration was observed in nasopharyngeal airway group after 30 minutes of noninvasive ventilation. More improvements in PaO2,PCO2,SBP, DBP, HR were observed 30 minutes after noninvasive ventilation with nasopharyngeal airway compared with control group (P<0.05). The endotracheal intubation was used in 31 cases (40.3%) in the oropharyngeal airway group, and among them, 19 cases (24.7%) suffered pulmonary infection. But there were 15 cases (19.2%) with endotracheal intubation in the nasopharyngeal airway group and 11 cases (14.1%) with pulmonary infection. The length of ICU stay, incidence of endotracheal intubation, and rate of pulmonary infection were lower in nasopharyngeal airway group (P < 0.05). Conclusions The nasopharyngeal airway used in noninvasive ventilation can effectively ameliorate ventilation dysfunction in stroke patients, correct hypoxia and lessen accumulation of carbon dioxide, also reduce the pulmonary infection and the rate of endotracheal intubation. Nasopharyngeal airway used in noninvasive ventilation is a effective modality to solve upper airway obstruction and offer effective ventilation in stroke patients. Key words: Nasopharyngeal tube; Oropharyngeal tube; Endotracheal intubation; Pulmonary infection