Clinical Application Of Prone Position Ventilation In The Treatment Of Stroke-associated Pneumonia

Objective:To explore the clinical efficacy and safety of prone position ventilation in the treatment of stroke-associated pneumonia.Method:This study is a single center,retrospective case analysis study,targeting acute stroke patients who met the inclusion criteria and were admitted to the Neurology Intensive Care Unit of the Neurology Intensive Care Unit of the First Affiliated Hospital of Nanchang University from August 2020 to December 2022.Record the changes of blood gas analysis[p H,arterial partial pressure of oxygen（PaO₂）,arterial partial pressure of carbon dioxide（Pa CO₂）and oxygenation index（PaO₂/FiO₂）],blood flow[heart rate（HR）,mean arterial pressure（MAP）,central venous pressure（CVP）]at each time point before prone position（T0）,2 hours of prone position ventilation（T1）,24 hours of prone position ventilation（T2）,and 48 hours of prone position ventilation（T3）,and compare whether the indicators before and after each time period are different through repeated measurement variance analysis.Complete chest CT examination before the patient undergoes prone position ventilation treatment,post process imaging data through CT quantitative analysis technology,and record the average CT value（CTmean）,total lung volume（TLV）,well ventilated lung volume（WALV）,poorly ventilated lung volume（LALV）,well ventilated lung tissue volume ratio（WALV%）,and poorly ventilated lung tissue volume ratio（LALV%）before and after ventilation to evaluate the improvement of lung ventilation.Result:1.A total of 44 patients with stroke-associated pneumonia were enrolled.The average APACHE II score of enrolled patients is（19.51±6.56）,the length of ICU stay is 16.0（10.0,24.0）days,and the number of days without mechanical ventilation is 6.0（1.0,9.0）days.2.After prone position ventilation,both PaO₂and PaO₂/FiO₂showed an increasing trend.The oxygenation index before prone position（T0）,after prone position ventilation for 2 hours（T1）,after prone position ventilation for 24 hours（T2）,and after prone position ventilation for 48 hours（T3）were（234.33±89.95）mm Hg,（253.23±117.87）mm Hg,（270.48±131.30）mm Hg,and（274.42±88.70）mm Hg,respectively,with statistically significant differences（P<0.05）.The partial pressure of oxygen（PaO₂）was（108.09±26.21）mm Hg,（115.11±43.11）mm Hg,（119.77±40.70）mm Hg,and（123.73±36.54）mm Hg,respectively,with statistically significant differences（P<0.05）.There was no statistically significant difference in heart rate（HR）,mean arterial pressure（MAP）,and central venous pressure（CVP）before and after prone position ventilation（P>0.05）.After 48 hours of prone position ventilation,the CTmean significantly decreased compared to before mechanical ventilation,and the difference was statistically significant（P<0.05）.Conclusion:Prone position ventilation can effectively improve the oxygenation index and lung CT value of patients with stroke-associated pneumonia in neurointensive care unit.It not only has no significant effect on hemorheology,but also improves the oxygenation index gradually with the extension of time.During ventilation,the incidence of adverse events is low and most of the symptoms are slightly reversible.Prone position ventilation is safe and feasible for patients with stroke-associated pneumonia.