Multidisciplinary Treatment Combined with Non-Pharmacological Airway Clearance Techniques for Preventing Stroke-Associated Pneumonia: A Quasi-Experimental Study

Multidisciplinary Treatment Combined with Non-Pharmacological Airway Clearance Techniques for Preventing Stroke-Associated Pneumonia: A Quasi-Experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Multidisciplinary Treatment Combined with Non-Pharmacological Airway Clearance Techniques for Preventing Stroke-Associated Pneumonia: A Quasi-Experimental Study Yingchun Chen, Lihong Huang, Xi Huang, Chao Wu, Yueli Gong, Jie Du, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6105418/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aims This study aims to evaluate the effectiveness of multidisciplinary treatment combined with non-pharmaceutical airway clearance technology in preventing stroke-associated pneumonia, and to provide reference for the prevention and management of stroke- associated pneumonia. Methods A quasi-experimental study was conducted at a Grade-A hospital in Siping City, China, from October 2023 to March 2024. A total of 160 stroke patients were recruited and randomly assigned to an intervention group (n = 80) or a control group (n = 80). 12 patients were excluded due to unstable conditions. The intervention group received multidisciplinary care combined with non-pharmaceutical air passage clearance technology, while the control group received conventional care. Key indicators such as SAP incidence, clinical pulmonary infection scores, intubation days, cure days, and hospital stay length were analyzed using SPSS 27.0. Results The incidence of SAP in intervention group was significantly lower than that in control group ( P < 0.001). Clinical pulmonary infection score of the intervention group was significantly lower than that of the control group following the intervention( P = 0.049). The impact of the intervention on pulmonary infection scores varied significantly across different time points ( P < 0.05). Similarly, the effects of the intervention on PaO 2 and PaCO 2 varied significantly over times ( P < 0.05). Furthermore, the intervention group exhibited significantly reduced tracheal intubation durations, days to cure, and hospital stay lengths compared to the control group. ( P < 0.001) However, there was no statistically significant difference in hospitalization costs between the two groups( P = 0.539). Conclusion This study demonstrated that a multidisciplinary intervention combined with non-pharmacological airway clearance techniques significantly reduced the incidence of pneumonia and improved clinical outcomes in stroke patients. Future research should focus on the cost-effectiveness of these interventions and their long-term impact on patient recovery. multidisciplinary diagnosis and treatment non-pharmacological airway clearance techniques stroke-associated pneumonia Figures Figure 1 Figure 2 1. Introduction Stroke is the second leading cause of death and disability worldwide(Murphy & Werring, 2020 ). A recent systematic review and meta-analysis of stroke in China, reveals a significant burden with a pooled annual prevalence of 1329.5 per 100,000 individuals and an incidence rate of 442.1 per 100,000. The mortality rate is 154.1 per 100,000, with a case fatality rate of 35.8%. Despite a decrease in case fatality, the increasing trend in prevalence and incidence underscores the necessity for enhanced stroke management strategies in China(Zhao et al., 2022 ). Medical complications after stroke affect functional recovery. Acute stroke damages the peripheral immune system and lung clearance, and patients have weak swallowing reflexes, so they are prone to aspiration of secretions, and then infection, increasing the risk of aspiration pneumonia(Eltringham et al., 2019 ). According to statistics, the incidence of respiratory tract infection caused by stroke is 7%-22%, which is one of the most important complications affecting the prognosis of stroke patients(ZHOU Lu, 2019).Data from foreign epidemiological studies show that the incidence of Stroke-associated Pneumonia (SAP)fluctuates between 7% and 38%(Ji et al., 2013 ; Smith et al., 2015 ; Teh et al., 2018 ; Yu et al., 2016 ). M. Gittins et al.(2023)showed that 45% of SAP patients died, while 12% of non-SAP patients died(Gittins et al., 2023 ). Notably, multiple studies have shown that SAP is associated with worse neurological recovery(Dong et al., 2020 -05 -01 ). SAP patients stay in hospital longer and have higher in-hospital mortality rates, increasing the cost of acute care for stroke and increasing the burden on families(Ali, 2017). In view of the adverse effects of SAP on the prognosis of stroke patients, its early prevention and timely intervention are crucial. The Chinese expert Consensus on SAP Diagnosis and Treatment (2019 Update edition) points out that airway management is an important means to prevent and treat SAP(Wang Yongjun, 2019). Airway clearance techniques (ACTs) employ a range of different strategies with the aim of removing excess secretions, reducing inflammatory responses and promoting lung healing(Belli et al., 2021 ).Thereby reducing the incidence and mortality of respiratory diseases. The non-pharmaceutical air passage clearance technique uses physical or mechanical means to control air flow and promote expectoration through coughing(Volsko, 2013 ). In terms of collaboration, particularly teamwork with an interdisciplinary approach, is a key factor in the quality of care in stroke services(Clarke & Forster, 2015 ). Multi-Disciplinary Team (MDT) model refers to the patient-centered, multi-disciplinary professionals as the support, case discussion as the main form, to provide patients with scientific diagnosis and treatment service.(Taberna et al., 2020 ) The MDT model has become a medical model actively advocated by the medical field at home and abroad.(Winters et al., 2021 ) Scholars have conducted numerous studies to prove that the MDT diagnosis and treatment mode has a positive effect in the treatment of both tumour and non-tumour diseases. Notably, MDT collaboration improved prognosis for severe COPD patients(Liu, 1 Jan. 2024). In addition ,Cochrane systematic review of inpatient stroke treatment trials, which found clear evidence that MDT provided organized inpatient care in stroke units improved outcomes("Organised inpatient (stroke unit) care for stroke," 2013).AdenijiO et al.(2023)have shown that organized MDT in resource-limited Settings can reduce in-hospital mortality in stroke patients(Adeniji et al., 2023 ). Currently, there are few studies on the prevention of stroke-associated pneumonia. Moreover, the preventive effect of non-drug airway clearance technology on stroke-associated pneumonia has not been reported. In China, the implementation of non-drug airway clearance technology is uneven due to inconsistencies in the standards of airway clearance techniques and nurse skill levels. Furthermore, there is a need for more data to support the efficacy and safety of this approach(Kim et al., 2019 ). Additionally, the exploration of multidisciplinary diagnosis and treatment models in China is still mainly focused on tumour treatment. This needs further development and improvement. In conclusion, this study will investigate the intervention effect of a multidisciplinary approach to diagnosis and treatment, in conjunction with non-drug airway clearance technology, on stroke patients. 2. Aim The objective of this study is to determine whether a comprehensive intervention can effectively assist patients in clearing airway secretions, controlling lung infections, improving ventilation and respiratory function, reducing the incidence of stroke-related pneumonia, shortening hospital stays and reducing costs. This study aims to develop targeted non-drug airway clearance programmes for stroke patients through professional training and multidisciplinary teams, and improve their quality of life. 3. Methods 3.1Research design A quasi-experimental study was conducted at a Grade-A hospital in Siping City of China. 3.2Sampling and grouping method In this study, the GPower software was employed for the estimation of the required sample size. The calculated sample size was 142 (N1=71, N2=71). The participants were selected using the convenient sampling method. The eligibility criteria were as follows: meet the clinical diagnostic criteria for stroke, first stroke, the result of stroke-associated pneumonia risk assessment scale was SAP risk (score ≤29), stable vital signs, patients and their families voluntarily participated in the study and signed informed consent. The study population consisted of 160 patients who had experienced a stroke and who met the inclusion criteria. They were recruited from four departments of neurology and neurosurgery in Siping City, China, between October 2023 and March 2024. The patients were randomly assigned to either the intervention group (n = 80) or the control group (n = 80). However, 12 patients were excluded from the study due to unstable conditions and other reasons. The control group comprised 72 cases, while the intervention group consisted of 76 cases. 3.3Survey tool and E valuation indicators The survey tools are as follows： （ 1 ） General Information Questionnaire The questionnaire was designed and compiled by the researcher. It mainly included the patient's age, gender, education level, main caregiver, medical payment method, stroke type, main injury site, treatment method, whether trachea intubation or pneumonectomy was performed, NIHSS score, GCS score, EAT-10 score, Kota drinking water test results, NRS2002 score, SAP risk assessment score, The Clinical Pulmonary Infection Score (CPIS), length of hospital stays and residence Hospital expenses, etc. （ 2 ） Stroke-associated pneumonia risk assessment Scale The scale was developed by Huang Jinping(Jinping Huang et al., 2014) et al. The scale comprises 14 items, using the Likert2-3 scoring method, with a total score ranging from 14 to 34 points, A score of 30 to 34 points indicates no risk, 25 to 29 points indicate mild risk, 19 to 24 points indicate moderate risk, and less than 18 points indicate great risk. The Cronbach's αcoefficient, retest reliability and expert evaluation content validity of the scale were 0.87, 0.91 and 0.96. （ 3 ） National Institutes of Health Stroke Scale (NIHSS) In 1989, Thmos(Patrick Lyden, 1999) developed the National Institutes of Health Stroke Scale (NIHSS), comprising 15 assessment items. Dongzhe Hou et al. (2012) evaluated the reliability and validity of the Chinese version of NIHSS. The Cronbach'sαvalues for partial reliability were 0.809 and 0.857, and the internal reliability Cronbach'sαvalues were 0.796. The findings demonstrated that the internal reliability, retest reliability and inter-rater reliability of the scale were all good(Hou et al., 2012). （ 4 ） Glasgow Coma Score (GCS) Glasgow Coma Score was developed by G. D. Teasdale and B. W. Jennett (1974). The scale comprises three sections: eye opening, speech and movement. The score of GCS ranges from 3 to 15 points, with a lower score indicating a deeper degree of disturbance of consciousness. A score of 13 to 14 indicates a mild disorder, 9 to 12 indicates a moderate disorder, and 3 to 8 is classified as a severe disorder. （ 5 ） Kota Drinking Water Test (WST) The Water Swallow Test (WST), proposed by Toshio Koda, is an assessment tool used to evaluate swallowing disorders(Zhang et al., 2024). The test results are categorized into the following grades: Grade 1, if completed within 5 seconds, is considered normal. Grade 1, if it takes more than 5 seconds, or Grade 2, is regarded as suspicious. Grades 3 to 5 indicate an abnormality. Research indicates that while the WST demonstrates high sensitivity in diagnosing dysphagia. （ 6 ） Eating Assessment Tool (EAT-10) The EAT-10 developed by foreign scholar Belafsky(Belafsky et al., 2008) (2008), employs a five-level scoring method, with "no" to "severe" representing 0 to 4 points, respectively, and a total score of up to 40 points. A score of 3 or above on the EAT-10 is indicative of an abnormal swallowing function, with higher scores correlating with an increased severity of the swallowing disorder. The Chinese version of the EAT-10 demonstrates satisfactory internal consistency, as evidenced by a Cronbach's αcoefficient of 0.845(Wang et al., 2015). （ 7 ） Clinical Pulmonary Infection Score (CPIS) The Clinical Pulmonary Infection Score (CPIS) was initially proposed by PUGIN in 1991. The CPIS provides a comprehensive evaluation of the severity of pulmonary infection, including clinical, imaging, and microbiological data. To predict the therapeutic effect and prognosis, and to provide guidance for the rational use of antibiotics. Shan Jun(Shan et al., 2011) et al. pointed out that the accuracy of CPIS in diagnosing pulmonary infections is good, with a sensitivity of 65% and a specificity of 64%. 3.4Interventions The control group received standard treatment and nursing care, which included maintaining an appropriate ward environment, respiratory care, oral hygiene, dietary assessment, early mobilization, psychological support, and infection monitoring. In contrast, the intervention group implemented a multidisciplinary non-pharmacological airway clearance treatment. The intervention contents are as follows: 1.Establish a multidisciplinary intervention team led by rehabilitation nurses, including heads of stroke-related departments, doctors, and other specialists. 2.Create standardized procedures, guidelines, and videos for airway clearance. 3.Provide airway clearance and pneumonia training to 53 nurses from stroke-related departments. 4.Specific intervention content: 4.1Use a risk assessment scale to assess patient risk; no intervention for low-risk patients. 4.2The head nurse of the neurology department assesses patients' consciousness, vital signs, and cooperation to identify high-risk patients, selects appropriate airway clearance technique, and develops individualized care plans. For patients with NIHSS ≤ 15 and GCS ≥ 8, apply respiratory techniques, chest physiotherapy, manual techniques, and mechanical devices for rehabilitation, along with health education for patients and families, continuously evaluating and optimizing treatment plans. For patients with NIHSS > 15 and GCS < 8, use mechanical devices for sputum clearance, coupled with family health education, and ongoing evaluation of clearance effectiveness to optimize treatment. 4.3Rehabilitation nurses and cardiopulmonary specialists teach airway clearance methods through video education, while nutritionists provide personalized meal plans. 4.4The deputy director of the infection control department supervises infection prevention measures. 4.5Neurology and neurosurgery nurses regularly monitor patients' vital signs and respiratory status, evaluating progress in multidisciplinary meetings and adjusting interventions as needed. The intervention process and methods are shown in Figure 1. 3.5Statistical methods Data analysis was conducted using SPSS 27.0 software. Comparisons were conducted using the χ² test, rank sum test, and independent samples t-tests. Repeated measures analysis of variance was conducted to examine the trends in clinical pulmonary infection scores, PaCO 2 , and PaO 2 over time across different groups. 4. Results 4.1Patients characteristics Over the course of the study, 12 patients were excluded from the study due to unstable conditions and other reasons. The study included a total of 148 participants, with 72 allocated to the control group and 76 to the intervention group. The mean age of the control group was higher than that of the intervention group. Significant differences were observed in age, dysphagia, and GCS score ( P 0.05). The SAP risk assessment scale was employed as the principal indicator to ascertain the baseline consistency between the control group and the intervention group. A summary of the patient characteristics is presented in Table 1. Table 1Comparison of baseline data between the two groups (N=148). Variables Control group (N=72) Intervention group (N=76) /t/ Z P Age (years) 70.83±6.89 62.78±11.89 -4.519 ＜ 0.001 Sex Male 35（48.6） 49（64.5） 3.790 0.052 Female 37（51.4） 27（35.5） Dysphagia Yes 69（95.8） 60（78.9） 9.421 0.002 No 3（4.2） 16（21.1） NIHSS 8（5~14） 9（6~18） -1.086 0.277 GCS 15（14~15） 12（11~14） -5.612 ＜ 0.001 NRS2002 4（2~5） 3（2~5） -0.588 0.557 SAP risk assessment 21.00（18.25~25.75） 22.50（18.25~25.75） -0.220 0.826 4.2 Comparison of SAP incidence A total of 49（68.10%）patients in the control group and 26（34.2%）patients in the intervention group were diagnosed with SAP. The incidence of SAP in control group was significantly higher than that in intervention group ( P < 0.001) (see Table 2). Table 2 Comparison of SAP incidence between the two groups (N=148). Group Total cases SAP cases SAP incidence （ p ） Control group 72 49 68.10% 16.944(＜0.001) Intervention group 76 26 34.20% 4.3 Comparison of clinical pulmonary infection scores, PaCO 2 and PaO 2 changes in two groups of SAP patients at different time points after intervention In Table 3, the repeated measures ANOVA demonstrated that the pulmonary infection score of the intervention group was significantly lower than that of the control group following the intervention( P =0.049). Similarly, a statistically significant time effect was observed for the clinical pulmonary infection score ( P < 0.001). Furthermore, the interaction between time and intervention was found to be statistically significant ( P < 0.001). Further analysis of simple effects and the contour interaction plot (see Figure 2) demonstrated that the impact of the intervention on pulmonary infection scores varied significantly across different time points ( P < 0.05). Nevertheless, the intervention did not yield a statistically significant effect on PaCO₂ ( P = 0.729) or PaO₂ ( P = 0.357). The time effect on PaCO₂ and PaO₂ was found to be statistically significant ( P < 0.001). Furthermore, the interaction between time and intervention was found to be statistically significant ( P < 0.001). Furthermore, Significant differences were observed in the changes of PaCO₂ and PaO₂ at different time points ( P < 0.05). In conclusion, the results indicate that the intervention was effective in reducing pulmonary infection scores, with the degree of effectiveness varying over time. The effects of the intervention on PaO 2 and PaCO 2 varied significantly at different time points. Table 3 Repeated measurements of clinical pulmonary infection scores, PaCO 2 and PaO 2 of SAP patients in two groups (N=76) Time Control group( N =50) Intervention group( N =26) t P Pulmonary infection score (CPIS) PaCO 2 PaO 2 T 1 9.80±1.57 10.27±1.08 5.549 0.179 T 2 8.24±1.59 7.38±0.94 7.769 0.014 T 3 6.74±1.49 5.23±1.11 1.845 ＜0.001 Intervention effect F=4.011, P =0.049 Time effect F=849.002， P ＜0.001 Time*Intervene F=50.674， P ＜0.001 T 1 55.14±9.32 58.54±7.08 -1.776 0.081 T 2 50.10±7.31 51.00±5.18 -6.210 0.537 T 3 45.18±5.17 42.46±4.21 2.309 0.024 Intervention effect F=0.121, P =0.729 Time effect F=234.021， P ＜0.001 Time*Intervene F=13.065， P ＜0.001 T 1 70.50±17.71 63.35±18.72 1.638 0.106 T 2 83.64±10.05 82.58±9.78 0.441 1.063 T 3 90.42±4.72 94.04±3.40 -3.833 ＜0.001 Intervention effect F=861, P =0.357 Time effect F=179.546， P ＜0.001 Time*Intervene F=8.134， P ＜0.001 Note: T 1 was the first 1d confirmed SAP; T 2 is the 4d of confirmed SAP; T 3 was the 7d of confirmed SAP 4.4Comparison of intubation days, curative days and hospital stay between two groups of patients with SAP infection In Table 4, the median duration of tracheal intubation in the control group was 16 days, while the median duration of tracheal intubation in the intervention group was 10 days. the duration of tracheal intubation in the intervention group was significantly shorter than that in the control group ( P < 0.001). The median number of cure days in the control group was 11 days. In contrast, the median number of cure days in the intervention group was 8 days. The number of cure days in the intervention group was significantly lower than that in the control group ( P < 0.001). The median length of hospital stay in the control group was 19.8 days, whereas the median length of hospital stay in the intervention group was 13.3 days. The length of hospital stay in the intervention group was significantly shorter than that in the control group( P <0.001). Furthermore, the median hospitalization expenses in the control group were 17,079.5 yuan, while the median hospitalization expenses in the intervention group were 17,716.6 yuan. There was no statistically significant difference in hospitalization expenses between the two groups( P =0.539). Table 4 Comparison of hospitalization conditions between the two groups (N=148) Group Intubation days（d） Cure days（d） Length of stay（d） Hospitalization expenses（yuan） Control group 16（13~46） 11（8~18.5） 19.8（13.9~25.9） 17079.5（12518.3~29543.3） Intervention group 10（8~11） 8 （7~8.25） 13.3（11.8~18.9） 17716.6（12040.3~23067.3） Z （ P ） -4.794 （＜0.001） -4.021 （＜0.001） -4.711 （＜0.001） -0.614 （0.539） 5. Discussion The results of the repeated measurement demonstrate a significant reduction in the incidence of SAP in the intervention group compared to the control group (34.2% vs. 68.1%, P < 0.001). This is consistent with the findings of Zhu‑Yun Liu (Liu et al., 2022 )et al, which emphasizes the importance of early identification of SAP risk factors in stroke patients, effective risk assessment and timely intervention in SAP prevention. A review of mechanical airway cleaning techniques has demonstrated that OPEP therapy can facilitate the clearance of airway mucus secretions and reduce the incidence of lung pathogens(Coppolo et al., 2021 ). Our study corroborates this finding and additionally confirms that timely intervention using non-pharmacological airway clearance techniques can substantially decrease the incidence of SAP. The results of the repeated measurement indicate that, following the intervention, the clinical pulmonary infection scores of the intervention group were significantly lower than those of the control group. Non-pharmacological airway clearance techniques were effective in reducing pulmonary infection scores, which gradually decreased over time. The results of the ANOVA of the blood gas analysis demonstrated a gradual decrease in the PaCO₂ of the control group and the intervention group, accompanied by a gradual increase in the PaO₂ over time, Significant differences were observed in the changes of PaCO₂ and PaO₂ at different time points, indicating that the intervention mode could effectively improve the ventilation function and respiratory function of SAP patients. This improvement aligns with findings from Hu Hongmei(Hu et al., 2023 ),who employed a pulmonary rehabilitation programme to treat non-SAP-infected stroke patients, resulting in improved CPIS scores and blood gas analysis results in the observation group after one week of intervention. The research results of Qiu Han(Han et al., 2019 )showed that the use of Portable fiberbronchoscope sputum aspiration could effectively reduce lung infection in SAP patients, improve ventilation, and promote the rehabilitation of stroke-associated pneumonia. Furthermore, Mo Mingyu(Mo et al., 2023 ) et al. used airway clearance technology to intervene in patients with stroke-related pneumonia, and the results showed that with the extension of intervention time, CPIS scores in the two groups decreased significantly. Multiple studies have found that airway clearance technology could effectively reduce sputum in patients with stroke-related pneumonia and improve hypoxia symptoms in patients. Additionally, the duration of intubation and the healing time for SAP-infected patients in the intervention group were both significantly shorter compared to those in the control group. QiuboZhang(Qiubo Zhang, 2022 )et al. demonstrated that effective airway management and early pulmonary rehabilitation can significantly reduce the duration of mechanical ventilation, accelerate patient recovery, and improve clinical outcomes. Moreover, the mean length of hospitalisation for patients in the intervention group was significantly shorter than that of the control group, which is consistent with the findings of the HuHongmei(Hu et al., 2023 ) study. This provides further evidence that comprehensive multidisciplinary collaboration and non-pharmaceutical airway clearance technology can effectively reduce hospital stay and improve rehabilitation outcomes. Nevertheless, no statistically significant discrepancy was observed in hospital costs between the control and intervention groups ( P > 0.05). This may be due to the additional treatment costs associated with the utilisation of multiple airway clearance techniques, leading to an overall increase in hospital costs. Future research should explore the cost-effectiveness of these interventions and consider strategies to optimize their economic impact while maintaining high-quality patient care. 6. Conclusion This study demonstrate that the comprehensive intervention mode utilising non-pharmaceutical airway clearance technology can markedly reduce the incidence of SAP in stroke patients, minimise the necessity for intubation and hospitalisation, and enhance the quality of care. Future research should explore the cost-benefit ratio of these interventions and their long-term impacts on patient outcomes. Abbreviations SAP Stroke-associated Pneumonia ACT Airway clearance techniques MDT Multi-Disciplinary Team COPD Chronic Obstructive Pulmonary Disease CPIS Clinical Pulmonary Infection Score NIHSS National Institutes of Health Stroke Scale GCS Glasgow Coma Score EAT Eating Assessment Tool NRS Nutritional Risk Screening WST Water Swallow Test ANOVA Analysis of Variance OPEP Oscillating Positive Expiratory Pressure Declarations Ethics approval The ethics approval including participants’ approach and recruitment were granted by the Siping City Central People's Hospital (SKYLW-2024-001). Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Contributors Study design, manuscript writing and editing: All authors. Data collection: YCC, YL, CW, YLG and JD, Data analysis: YCC, YL, LHH and XH. We confirm that all authors meet the authorship criteria and that all authors are in agreement with the content of the manuscript. Funding This study was supported by the Fujian Province Social Science Foundation of China (FJ2022B061)，Xiamen Nursing Association of China（XMSHLXH2320）and the first-class undergraduate program《Fundamental nursing Ⅱ》 in Fujian Province. Patient consent for publication Not required. Clinical trial number Not applicable. Statistical data The author(s) affirm that the methods used in the data analyses are suitably applied to their data within their study design and context, and the statistical findings have been implemented and interpreted correctly. Data availability statement The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Acknowledgment The authors sincerely thank all the team members, healthcare professionals, and patients for their participation and support in this study. References Adeniji O, Adeleye O, Akinyemi J, Otubogun F, Ogunde G, Ogunrombi M, Adesina D, Wahab A, Ogunlana M, Alimi T, Akinyemi R. Organized multi-disciplinary stroke team care improves acute stroke outcomes in resource limited settings; Results of a retrospective study from a Nigerian tertiary hospital. 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Diagnostic Accuracy of Clinical Pulmonary Infection Score for Ventilator-Associated Pneumonia: A Meta-analysis. Respir Care. 2011;56(8):1087–94. https://doi.org/10.4187/respcare.01097 . Smith CJ, Bray BD, Hoffman A, Meisel A, Heuschmann PU, Wolfe CDA, Tyrrell PJ, Rudd AG. Can a Novel Clinical Risk Score Improve Pneumonia Prediction in Acute Stroke Care? A UK Multicenter Cohort Study. J Am Heart Association. 2015;4(1). https://doi.org/10.1161/jaha.114.001307 . Taberna M, Gil Moncayo F, Jané-Salas E, Antonio M, Arribas L, Vilajosana E, Peralvez Torres E, Mesía R. The Multidisciplinary Team (MDT) Approach and Quality of Care. Front Oncol. 2020;10. https://doi.org/10.3389/fonc.2020.00085 . Teh WH, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM, Potter JF, Myint PK. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand. 2018;138(4):293–300. https://doi.org/10.1111/ane.12956 . Volsko TA. Airway Clearance Therapy: Finding the Evidence. Respir Care. 2013;58(10):1669–78. https://doi.org/10.4187/respcare.02590 . Wang R, Xiong X, Zhang C, Fan Y. The sensitivity and specificity of the Chinese eating assessment tool (EAT-10) for screening oropharyngeal dysphagia in acute stroke patients. Chin J Phys Med Rehabilitation. 2015 https://doi.org/10.11817/j.issn.1672­7347.2015.12.017 . Wang Yongjun CY, Chuanzhu LV, Xingquan ZHAO, Wei GUO. Expert Consensus on the Diagnosis and Treatment of stroke-related pneumonia in China (2019 Update). Chin J Emerg Med. 2019. https://doi.org/10.3969/j.issn.1673-5765.2019.12.011 . Winters DA, Soukup T, Sevdalis N, Green JSA, Lamb BW. The cancer multidisciplinary team meeting: in need of change? History, challenges and future perspectives. BJU Int. 2021;128(3):271–9. https://doi.org/10.1111/bju.15495 . Yu Y-J, Weng W-C, Su F-C, Peng T-I, Chien Y-Y, Wu C-L, Lee K-Y, Wei Y-C, Lin S-W, Zhu J-X, Huang W-Y. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. J Clin Neurosci. 2016;33:124–8. https://doi.org/10.1016/j.jocn.2016.02.039 . Zhang Y, Wang Y, Zhu Y, Wan H. Diagnostic value of water swallow test for dysphagia in patients with head and neck cancer: A systematic review and meta-analysis. Head Neck. 2024;46(5):1210–23. https://doi.org/10.1002/hed.27713 . Zhao Y, Hua X, Ren X, Ouyang M, Chen C, Li Y, Yin X, Song P, Chen X, Wu S, Song L, Anderson CS. Increasing burden of stroke in China: A systematic review and meta-analysis of prevalence, incidence, mortality, and case fatality. Int J Stroke. 2022;18(3):259–67. https://doi.org/10.1177/17474930221135983 . Lu ZHOU, Gao CXLIU, Weifang YOU, CAI Enli. Metaanalysis of clinical effect of nursing intervention on strokeassociated pneumonia. Clin Nurs Res. 2019;33(01):22–8. https://doi.org/10.12102/j.issn.1009-6493.2019.01.006 . 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Fujian","correspondingAuthor":false,"prefix":"","firstName":"Lihong","middleName":"","lastName":"Huang","suffix":""},{"id":422189790,"identity":"82f361df-7e01-4328-b2e8-c01be134417b","order_by":2,"name":"Xi Huang","email":"","orcid":"","institution":"School of Medicine, Xiamen University, Xiamen, Fujian","correspondingAuthor":false,"prefix":"","firstName":"Xi","middleName":"","lastName":"Huang","suffix":""},{"id":422189791,"identity":"53bcce57-e97b-4f40-8155-2fe20325bd63","order_by":3,"name":"Chao Wu","email":"","orcid":"","institution":"Siping City Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Wu","suffix":""},{"id":422189792,"identity":"d25a5c86-03c6-4f7f-b3f1-d000df1ae63e","order_by":4,"name":"Yueli Gong","email":"","orcid":"","institution":"Siping City Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yueli","middleName":"","lastName":"Gong","suffix":""},{"id":422189793,"identity":"13c459ea-7053-4353-a9ac-e9a96011fc37","order_by":5,"name":"Jie Du","email":"","orcid":"","institution":"Siping City Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Du","suffix":""},{"id":422189794,"identity":"75ea4bc3-efd8-4ae4-b819-aaf2411da6c8","order_by":6,"name":"Jiawen You","email":"","orcid":"","institution":"School of Medicine, Xiamen University, Xiamen, Fujian","correspondingAuthor":false,"prefix":"","firstName":"Jiawen","middleName":"","lastName":"You","suffix":""},{"id":422189795,"identity":"78af6cff-b499-4671-9ce1-9d60fa637be2","order_by":7,"name":"Yang Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYBACPmYIzcPP33wAwjxAQAsbVIuM5IxjCURqgdI2BgdyDIjUws5jJvFzRy0Pw4Ez36RutjHI8d1IYPxcgNdhPGaSvWeO8zA29242zm1jMJa8kcAsPYOAFgnetmM8zAxnNz4GaknccCMBKEjIlr9ALWwMOQ8OA7XUE6VFmrethoeHIYcRZEuCAWEtbMXWsm0HeCQkjhkb55yTMJx55mGzND4t/PyHN95821Znb3+++Zl0TpmNPN/x5IOf8WkBAhYJBobDMA6QzcDYgF8DAwPzBwaGOkKKRsEoGAWjYCQDAAE3RE70Ig5NAAAAAElFTkSuQmCC","orcid":"","institution":"School of Medicine, Xiamen University, Xiamen, Fujian","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-02-25 13:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6105418/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6105418/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77682408,"identity":"8c774e88-76ef-4500-98fa-aed5ed824b7d","added_by":"auto","created_at":"2025-03-04 08:48:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":206268,"visible":true,"origin":"","legend":"\u003cp\u003eIntervention process of non-pharmaceutical air passage clearance technique\u003c/p\u003e","description":"","filename":"floatimage117.png","url":"https://assets-eu.researchsquare.com/files/rs-6105418/v1/7c8ce7990fd731f649878eba.png"},{"id":77684159,"identity":"b1319bdb-a927-4621-9e1b-1b8014f418d5","added_by":"auto","created_at":"2025-03-04 08:56:14","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":92340,"visible":true,"origin":"","legend":"\u003cp\u003eSimple effect analysis diagram of clinical pulmonary infection score, PaCO\u003csub\u003e2\u003c/sub\u003eand PaO\u003csub\u003e2\u003c/sub\u003e in two groups of SAP patients\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6105418/v1/0e1932958ff65dfacb5298eb.jpeg"},{"id":80816460,"identity":"28c3b339-0b20-447c-9d30-409ab23bc17a","added_by":"auto","created_at":"2025-04-17 11:16:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1227486,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6105418/v1/73efe9b4-55bf-4483-8d4f-949a3c4c9930.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Multidisciplinary Treatment Combined with Non-Pharmacological Airway Clearance Techniques for Preventing Stroke-Associated Pneumonia: A Quasi-Experimental Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eStroke is the second leading cause of death and disability worldwide(Murphy \u0026amp; Werring, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A recent systematic review and meta-analysis of stroke in China, reveals a significant burden with a pooled annual prevalence of 1329.5 per 100,000 individuals and an incidence rate of 442.1 per 100,000. The mortality rate is 154.1 per 100,000, with a case fatality rate of 35.8%. Despite a decrease in case fatality, the increasing trend in prevalence and incidence underscores the necessity for enhanced stroke management strategies in China(Zhao et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMedical complications after stroke affect functional recovery. Acute stroke damages the peripheral immune system and lung clearance, and patients have weak swallowing reflexes, so they are prone to aspiration of secretions, and then infection, increasing the risk of aspiration pneumonia(Eltringham et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). According to statistics, the incidence of respiratory tract infection caused by stroke is 7%-22%, which is one of the most important complications affecting the prognosis of stroke patients(ZHOU Lu, 2019).Data from foreign epidemiological studies show that the incidence of Stroke-associated Pneumonia (SAP)fluctuates between 7% and 38%(Ji et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Smith et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Teh et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Yu et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). M. Gittins et al.(2023)showed that 45% of SAP patients died, while 12% of non-SAP patients died(Gittins et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Notably, multiple studies have shown that SAP is associated with worse neurological recovery(Dong et al., 2020 -05 -01 ). SAP patients stay in hospital longer and have higher in-hospital mortality rates, increasing the cost of acute care for stroke and increasing the burden on families(Ali, 2017). In view of the adverse effects of SAP on the prognosis of stroke patients, its early prevention and timely intervention are crucial. The Chinese expert Consensus on SAP Diagnosis and Treatment (2019 Update edition) points out that airway management is an important means to prevent and treat SAP(Wang Yongjun, 2019).\u003c/p\u003e \u003cp\u003eAirway clearance techniques (ACTs) employ a range of different strategies with the aim of removing excess secretions, reducing inflammatory responses and promoting lung healing(Belli et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).Thereby reducing the incidence and mortality of respiratory diseases. The non-pharmaceutical air passage clearance technique uses physical or mechanical means to control air flow and promote expectoration through coughing(Volsko, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In terms of collaboration, particularly teamwork with an interdisciplinary approach, is a key factor in the quality of care in stroke services(Clarke \u0026amp; Forster, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Multi-Disciplinary Team (MDT) model refers to the patient-centered, multi-disciplinary professionals as the support, case discussion as the main form, to provide patients with scientific diagnosis and treatment service.(Taberna et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) The MDT model has become a medical model actively advocated by the medical field at home and abroad.(Winters et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Scholars have conducted numerous studies to prove that the MDT diagnosis and treatment mode has a positive effect in the treatment of both tumour and non-tumour diseases. Notably, MDT collaboration improved prognosis for severe COPD patients(Liu, 1 Jan. 2024). In addition ,Cochrane systematic review of inpatient stroke treatment trials, which found clear evidence that MDT provided organized inpatient care in stroke units improved outcomes(\"Organised inpatient (stroke unit) care for stroke,\" 2013).AdenijiO et al.(2023)have shown that organized MDT in resource-limited Settings can reduce in-hospital mortality in stroke patients(Adeniji et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCurrently, there are few studies on the prevention of stroke-associated pneumonia. Moreover, the preventive effect of non-drug airway clearance technology on stroke-associated pneumonia has not been reported. In China, the implementation of non-drug airway clearance technology is uneven due to inconsistencies in the standards of airway clearance techniques and nurse skill levels. Furthermore, there is a need for more data to support the efficacy and safety of this approach(Kim et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, the exploration of multidisciplinary diagnosis and treatment models in China is still mainly focused on tumour treatment. This needs further development and improvement. In conclusion, this study will investigate the intervention effect of a multidisciplinary approach to diagnosis and treatment, in conjunction with non-drug airway clearance technology, on stroke patients.\u003c/p\u003e"},{"header":"2. Aim","content":"\u003cp\u003eThe objective of this study is to determine whether a comprehensive intervention can effectively assist patients in clearing airway secretions, controlling lung infections, improving ventilation and respiratory function, reducing the incidence of stroke-related pneumonia, shortening hospital stays and reducing costs. This study aims to develop targeted non-drug airway clearance programmes for stroke patients through professional training and multidisciplinary teams, and improve their quality of life.\u003c/p\u003e"},{"header":"3. Methods","content":"\u003cp\u003e\u003cstrong\u003e3.1Research design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA quasi-experimental study was conducted at a Grade-A hospital in Siping City of China.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2Sampling and grouping method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the GPower software was employed for the estimation of the required sample size. The calculated sample size was 142 (N1=71, N2=71). The participants were selected using the convenient sampling method. The eligibility criteria were as follows: meet the clinical diagnostic criteria for stroke, first stroke, the result of stroke-associated pneumonia risk assessment scale was SAP risk (score \u0026le;29), stable vital signs, patients and their families voluntarily participated in the study and signed informed consent. The study population consisted of 160 patients who had experienced a stroke and who met the inclusion criteria. They were recruited from four departments of neurology and neurosurgery in Siping City, China, between October 2023 and March 2024. The patients were randomly assigned to either the intervention group (n = 80) or the control group (n = 80). However, 12 patients were excluded from the study due to unstable conditions and other reasons. The control group comprised 72 cases, while the intervention group consisted of 76 cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3Survey tool\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and E\u003c/strong\u003e\u003cstrong\u003evaluation indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey tools are as follows：\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003eGeneral Information Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was designed and compiled by the researcher. It mainly included the patient\u0026apos;s age, gender, education level, main caregiver, medical payment method, stroke type, main injury site, treatment method, whether trachea intubation or pneumonectomy was performed, NIHSS score, GCS score, EAT-10 score, Kota drinking water test results, NRS2002 score, SAP risk assessment score, The Clinical Pulmonary Infection Score (CPIS), length of hospital stays and residence Hospital expenses, etc.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003eStroke-associated pneumonia risk assessment Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe scale was developed by Huang Jinping(Jinping Huang et al., 2014) et al. The scale\u0026nbsp;comprises 14 items, using the Likert2-3 scoring method, with a total score ranging from 14 to 34 points, A score of 30 to 34 points indicates no risk, 25 to 29 points indicate mild risk, 19 to 24 points indicate moderate risk, and less than 18 points indicate great risk. The Cronbach\u0026apos;s\u0026nbsp;\u0026alpha;coefficient, retest reliability and expert evaluation content validity of the scale were\u0026nbsp;0.87, 0.91 and 0.96.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003eNational Institutes of Health Stroke Scale (NIHSS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 1989, Thmos(Patrick Lyden, 1999) developed the National Institutes of Health Stroke Scale (NIHSS), comprising 15 assessment items. Dongzhe Hou et al. (2012) evaluated the reliability and validity of the Chinese version of NIHSS. The Cronbach\u0026apos;s\u0026alpha;values for partial reliability were 0.809 and 0.857, and the internal reliability Cronbach\u0026apos;s\u0026alpha;values were 0.796. The findings demonstrated that the internal reliability, retest reliability and inter-rater reliability of the scale were all good(Hou et al., 2012).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003eGlasgow Coma Score (GCS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlasgow Coma Score was developed by G. D. Teasdale and B. W. Jennett (1974). The scale comprises three sections: eye opening, speech and movement. The score of GCS ranges from 3 to 15 points, with a lower score indicating a deeper degree of disturbance of consciousness. A score of 13 to 14 indicates a mild disorder, 9 to 12 indicates a moderate disorder, and 3 to 8 is classified as a severe disorder.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Kota Drinking Water Test (WST)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Water Swallow Test (WST), proposed by Toshio Koda, is an assessment tool used to evaluate swallowing disorders(Zhang et al., 2024). The test results are categorized into the following grades: Grade 1, if completed within 5 seconds, is considered normal. Grade 1, if it takes more than 5 seconds, or Grade 2, is regarded as suspicious. Grades 3 to 5 indicate an abnormality. Research indicates that while the WST demonstrates high sensitivity in diagnosing dysphagia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Eating Assessment Tool (EAT-10)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe EAT-10 developed by foreign scholar Belafsky(Belafsky et al., 2008) (2008), employs a five-level scoring method, with \u0026quot;no\u0026quot; to \u0026quot;severe\u0026quot; representing 0 to 4 points, respectively, and a total score of up to 40 points. A score of 3 or above on the EAT-10 is indicative of an abnormal swallowing function, with higher scores correlating with an increased severity of the swallowing disorder. The Chinese version of the EAT-10 demonstrates satisfactory internal consistency, as evidenced by a Cronbach\u0026apos;s \u0026alpha;coefficient of 0.845(Wang et al., 2015).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003eClinical Pulmonary Infection Score (CPIS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Clinical Pulmonary Infection Score (CPIS) was initially proposed by PUGIN in 1991. The CPIS provides a comprehensive evaluation of the severity of pulmonary infection, including clinical, imaging, and microbiological data. To predict the therapeutic effect and prognosis, and to provide guidance for the rational use of antibiotics. Shan Jun(Shan et al., 2011) et al. pointed out that the accuracy of CPIS in diagnosing pulmonary infections is good, with a sensitivity of 65% and a specificity of 64%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4Interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe control group received standard treatment and nursing care, which included maintaining an appropriate ward environment, respiratory care, oral hygiene, dietary assessment, early mobilization, psychological support, and infection monitoring. In contrast, the intervention group implemented a multidisciplinary non-pharmacological airway clearance treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe intervention contents are as follows:\u003c/p\u003e\n\u003cp\u003e1.Establish a multidisciplinary intervention team led by rehabilitation nurses, including heads of stroke-related departments, doctors, and other specialists.\u003c/p\u003e\n\u003cp\u003e2.Create standardized procedures, guidelines, and videos for airway clearance.\u003c/p\u003e\n\u003cp\u003e3.Provide airway clearance and pneumonia training to 53 nurses from stroke-related departments.\u003c/p\u003e\n\u003cp\u003e4.Specific intervention content:\u003c/p\u003e\n\u003cp\u003e4.1Use a risk assessment scale to assess patient risk; no intervention for low-risk patients.\u003c/p\u003e\n\u003cp\u003e4.2The head nurse of the neurology department assesses patients\u0026apos; consciousness, vital signs, and cooperation to identify high-risk patients, selects appropriate airway clearance technique, and develops individualized care plans. For patients with NIHSS \u0026le; 15 and GCS \u0026ge; 8, apply respiratory techniques, chest physiotherapy, manual techniques, and mechanical devices for rehabilitation, along with health education for patients and families, continuously evaluating and optimizing treatment plans. For patients with NIHSS \u0026gt; 15 and GCS \u0026lt; 8, use mechanical devices for sputum clearance, coupled with family health education, and ongoing evaluation of clearance effectiveness to optimize treatment.\u003c/p\u003e\n\u003cp\u003e4.3Rehabilitation nurses and cardiopulmonary specialists teach airway clearance methods through video education, while nutritionists provide personalized meal plans.\u003c/p\u003e\n\u003cp\u003e4.4The deputy director of the infection control department supervises infection prevention measures.\u003c/p\u003e\n\u003cp\u003e4.5Neurology and neurosurgery nurses regularly monitor patients\u0026apos; vital signs and respiratory status, evaluating progress in multidisciplinary meetings and adjusting interventions as needed. The intervention process and methods are shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5Statistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was conducted using SPSS 27.0 software. Comparisons were conducted using the \u0026chi;\u0026sup2; test, rank sum test, and independent samples t-tests. Repeated measures analysis of variance was conducted to examine the trends in clinical pulmonary infection scores, PaCO\u003csub\u003e2\u003c/sub\u003e, and PaO\u003csub\u003e2\u003c/sub\u003e over time across different groups.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cp\u003e\u003cstrong\u003e4.1Patients characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver the course of the study, 12 patients were excluded from the study due to unstable conditions and other reasons. The study included a total of 148 participants, with 72 allocated to the control group and 76 to the intervention group. The mean age of the control group was higher than that of the intervention group. Significant differences were observed in age, dysphagia, and GCS score (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01). No significant differences were observed in gender, NRS2002 score, NIHSS score, or SAP risk assessment score between the control group and the intervention group (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05). The SAP risk assessment scale was employed as the principal indicator to ascertain the baseline consistency between the control group and the intervention group. A summary of the patient characteristics is presented in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1Comparison of baseline data between the two groups (N=148).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"105%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(N=72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003cp\u003e(N=76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e/t/\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e70.83\u0026plusmn;6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e62.78\u0026plusmn;11.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-4.519\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e＜\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eSex \u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e35（48.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e49（64.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3.790\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.052\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e37（51.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e27（35.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eDysphagia Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e69（95.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e60（78.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.421\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e3（4.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e16（21.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eNIHSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e8（5~14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e9（6~18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-1.086\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.277\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eGCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e15（14~15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e12（11~14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-5.612\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e＜\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eNRS2002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e4（2~5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e3（2~5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eSAP risk assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e21.00（18.25~25.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e22.50（18.25~25.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.220\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003e4.2\u003c/strong\u003e\u003cstrong\u003eComparison of SAP incidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 49（68.10%）patients in the control group and 26（34.2%）patients in the intervention group were diagnosed with SAP. The incidence of SAP in control group was significantly higher than that in intervention group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) (see Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2\u0026nbsp;Comparison of SAP incidence between the two groups (N=148).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eTotal cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eSAP cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003eSAP incidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e（\u003cem\u003ep\u003c/em\u003e）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e68.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e16.944(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e34.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003e4.3\u003c/strong\u003e \u003cstrong\u003eComparison of clinical pulmonary infection scores, PaCO\u003csub\u003e2\u003c/sub\u003e and PaO\u003csub\u003e2\u003c/sub\u003e changes in two groups of SAP patients at different time points after intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Table 3, the repeated measures ANOVA demonstrated that the pulmonary infection score of the intervention group was significantly lower than that of the control group following the intervention(\u003cem\u003eP\u003c/em\u003e=0.049). Similarly, a statistically significant time effect was observed for the clinical pulmonary infection score (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Furthermore, the interaction between time and intervention was found to be statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Further analysis of simple effects and the contour interaction plot (see Figure 2) demonstrated that the impact of the intervention on pulmonary infection scores varied significantly across different time points (\u003cem\u003eP\u003c/em\u003e\u003csub\u003e\u0026nbsp;\u003c/sub\u003e\u0026lt; 0.05). Nevertheless, the intervention did not yield a statistically significant effect on PaCO₂ (\u003cem\u003eP\u003c/em\u003e = 0.729) or PaO₂ (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.357). The time effect on PaCO₂ and PaO₂ was found to be statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Furthermore, the interaction between time and intervention was found to be statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Furthermore, Significant differences were observed in the changes of PaCO₂ and PaO₂ at different time points (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05). In conclusion, the results indicate that the intervention was effective in reducing pulmonary infection scores, with the degree of effectiveness varying over time. The effects of the intervention on PaO\u003csub\u003e2\u003c/sub\u003e and PaCO\u003csub\u003e2\u003c/sub\u003e varied significantly at different time points.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eRepeated measurements of clinical pulmonary infection scores, PaCO\u003csub\u003e2\u003c/sub\u003eand PaO\u003csub\u003e2\u003c/sub\u003e of SAP patients in two groups (N=76)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"115%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eControl group(\u003cem\u003eN\u003c/em\u003e=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003eIntervention group(\u003cem\u003eN\u003c/em\u003e=26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"18\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003ePulmonary infection score\u003c/p\u003e\n \u003cp\u003e(CPIS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003ePaCO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003ePaO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e9.80\u0026plusmn;1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e10.27\u0026plusmn;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e8.24\u0026plusmn;1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e7.38\u0026plusmn;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e7.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e6.74\u0026plusmn;1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e5.23\u0026plusmn;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.845\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIntervention effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;F=4.011,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e=0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTime effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 46px;\"\u003e\n \u003cp\u003eF=849.002，\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cem\u003eP\u003c/em\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTime*Intervene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 46px;\"\u003e\n \u003cp\u003eF=50.674，\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cem\u003eP\u003c/em\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp; 55.14\u0026plusmn;9.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e58.54\u0026plusmn;7.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-1.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp; 50.10\u0026plusmn;7.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e51.00\u0026plusmn;5.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-6.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp; 45.18\u0026plusmn;5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e42.46\u0026plusmn;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIntervention effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eF=0.121,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e=0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTime effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 46px;\"\u003e\n \u003cp\u003eF=234.021，\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cem\u003eP\u003c/em\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTime*Intervene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 46px;\"\u003e\n \u003cp\u003eF=13.065，\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cem\u003eP\u003c/em\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e70.50\u0026plusmn;17.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e63.35\u0026plusmn;18.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e83.64\u0026plusmn;10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e82.58\u0026plusmn;9.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eT\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e90.42\u0026plusmn;4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e94.04\u0026plusmn;3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-3.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIntervention effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eF=861,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e=0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTime effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 46px;\"\u003e\n \u003cp\u003eF=179.546，\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u003cem\u003eP\u003c/em\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eTime*Intervene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 46px;\"\u003e\n \u003cp\u003eF=8.134，\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cem\u003eP\u003c/em\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003eNote: T\u003csub\u003e1\u003c/sub\u003e was the first 1d confirmed SAP; T\u003csub\u003e2\u0026nbsp;\u003c/sub\u003eis the 4d of confirmed SAP; T\u003csub\u003e3\u003c/sub\u003e was the 7d of confirmed SAP\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4Comparison of intubation days, curative days and hospital stay between two groups of patients with SAP infection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Table 4, the median duration of tracheal intubation in the control group was 16 days, while the median duration of tracheal intubation in the intervention group was 10 days. the duration of tracheal intubation in the intervention group was significantly shorter than that in the control group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). The median number of cure days in the control group was 11 days. In contrast, the median number of cure days in the intervention group was 8 days. The number of cure days in the intervention group was significantly lower than that in the control group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). The median length of hospital stay in the control group was 19.8 days, whereas the median length of hospital stay in the intervention group was 13.3 days. The length of hospital stay in the intervention group was significantly shorter than that in the control group(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Furthermore, the median hospitalization expenses in the control group were 17,079.5 yuan, while the median hospitalization expenses in the intervention group were 17,716.6 yuan. There was no statistically significant difference in hospitalization expenses between the two groups(\u003cem\u003eP\u003c/em\u003e=0.539).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eComparison of hospitalization conditions between the two groups (N=148)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" style=\"margin-right: calc(0%); width: 100%;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"\" style=\"width: 16.7726%;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5019%;\"\u003e\n \u003cp\u003eIntubation days（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.3914%;\"\u003e\n \u003cp\u003eCure days（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5845%;\"\u003e\n \u003cp\u003eLength of stay（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7497%;\"\u003e\n \u003cp\u003eHospitalization expenses（yuan）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.7726%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5019%;\"\u003e\n \u003cp\u003e16（13~46）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.3914%;\"\u003e\n \u003cp\u003e11（8~18.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5845%;\"\u003e\n \u003cp\u003e19.8（13.9~25.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7497%;\"\u003e\n \u003cp\u003e17079.5（12518.3~29543.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.7726%;\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5019%;\"\u003e\n \u003cp\u003e\u0026nbsp;10（8~11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.3914%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e（7~8.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5845%;\"\u003e\n \u003cp\u003e13.3（11.8~18.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7497%;\"\u003e\n \u003cp\u003e17716.6（12040.3~23067.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.7726%;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e（\u003cem\u003eP\u003c/em\u003e）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5019%;\"\u003e\n \u003cp\u003e-4.794\u003c/p\u003e\n \u003cp\u003e（＜0.001）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3914%;\"\u003e\n \u003cp\u003e-4.021\u003c/p\u003e\n \u003cp\u003e（＜0.001）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5845%;\"\u003e\n \u003cp\u003e-4.711\u003c/p\u003e\n \u003cp\u003e（＜0.001）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.7497%;\"\u003e\n \u003cp\u003e-0.614\u003c/p\u003e\n \u003cp\u003e（0.539）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThe results of the repeated measurement demonstrate a significant reduction in the incidence of SAP in the intervention group compared to the control group (34.2% vs. 68.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This is consistent with the findings of Zhu‑Yun Liu (Liu et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)et al, which emphasizes the importance of early identification of SAP risk factors in stroke patients, effective risk assessment and timely intervention in SAP prevention. A review of mechanical airway cleaning techniques has demonstrated that OPEP therapy can facilitate the clearance of airway mucus secretions and reduce the incidence of lung pathogens(Coppolo et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Our study corroborates this finding and additionally confirms that timely intervention using non-pharmacological airway clearance techniques can substantially decrease the incidence of SAP.\u003c/p\u003e \u003cp\u003eThe results of the repeated measurement indicate that, following the intervention, the clinical pulmonary infection scores of the intervention group were significantly lower than those of the control group. Non-pharmacological airway clearance techniques were effective in reducing pulmonary infection scores, which gradually decreased over time. The results of the ANOVA of the blood gas analysis demonstrated a gradual decrease in the PaCO₂ of the control group and the intervention group, accompanied by a gradual increase in the PaO₂ over time, Significant differences were observed in the changes of PaCO₂ and PaO₂ at different time points, indicating that the intervention mode could effectively improve the ventilation function and respiratory function of SAP patients. This improvement aligns with findings from Hu Hongmei(Hu et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e),who employed a pulmonary rehabilitation programme to treat non-SAP-infected stroke patients, resulting in improved CPIS scores and blood gas analysis results in the observation group after one week of intervention. The research results of Qiu Han(Han et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)showed that the use of Portable fiberbronchoscope sputum aspiration could effectively reduce lung infection in SAP patients, improve ventilation, and promote the rehabilitation of stroke-associated pneumonia. Furthermore, Mo Mingyu(Mo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) et al. used airway clearance technology to intervene in patients with stroke-related pneumonia, and the results showed that with the extension of intervention time, CPIS scores in the two groups decreased significantly. Multiple studies have found that airway clearance technology could effectively reduce sputum in patients with stroke-related pneumonia and improve hypoxia symptoms in patients.\u003c/p\u003e \u003cp\u003eAdditionally, the duration of intubation and the healing time for SAP-infected patients in the intervention group were both significantly shorter compared to those in the control group. QiuboZhang(Qiubo Zhang, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e )et al. demonstrated that effective airway management and early pulmonary rehabilitation can significantly reduce the duration of mechanical ventilation, accelerate patient recovery, and improve clinical outcomes. Moreover, the mean length of hospitalisation for patients in the intervention group was significantly shorter than that of the control group, which is consistent with the findings of the HuHongmei(Hu et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) study. This provides further evidence that comprehensive multidisciplinary collaboration and non-pharmaceutical airway clearance technology can effectively reduce hospital stay and improve rehabilitation outcomes. Nevertheless, no statistically significant discrepancy was observed in hospital costs between the control and intervention groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This may be due to the additional treatment costs associated with the utilisation of multiple airway clearance techniques, leading to an overall increase in hospital costs. Future research should explore the cost-effectiveness of these interventions and consider strategies to optimize their economic impact while maintaining high-quality patient care.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study demonstrate that the comprehensive intervention mode utilising non-pharmaceutical airway clearance technology can markedly reduce the incidence of SAP in stroke patients, minimise the necessity for intubation and hospitalisation, and enhance the quality of care. Future research should explore the cost-benefit ratio of these interventions and their long-term impacts on patient outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStroke-associated Pneumonia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAirway clearance techniques\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMulti-Disciplinary Team\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPIS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinical Pulmonary Infection Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNIHSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institutes of Health Stroke Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlasgow Coma Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEating Assessment Tool\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNutritional Risk Screening\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWater Swallow Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOPEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOscillating Positive Expiratory Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics approval including participants\u0026rsquo; approach and recruitment were granted by the Siping City Central People\u0026apos;s Hospital (SKYLW-2024-001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient and public involvement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design, manuscript writing and editing: All authors. Data collection: YCC, YL, CW, YLG and JD, Data analysis: YCC, YL, LHH and XH. We confirm that all authors meet the authorship criteria and that all authors are in agreement with the content of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Fujian Province Social Science Foundation of China (FJ2022B061)，Xiamen Nursing Association of China（XMSHLXH2320）and the first-class undergraduate program《Fundamental nursing Ⅱ》\u0026nbsp;in Fujian Province.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) affirm that the methods used in the data analyses are suitably applied to their data within their study design and context, and the statistical findings have been implemented and interpreted correctly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank all the team members, healthcare professionals, and patients for their participation and support in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdeniji O, Adeleye O, Akinyemi J, Otubogun F, Ogunde G, Ogunrombi M, Adesina D, Wahab A, Ogunlana M, Alimi T, Akinyemi R. Organized multi-disciplinary stroke team care improves acute stroke outcomes in resource limited settings; Results of a retrospective study from a Nigerian tertiary hospital. 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Metaanalysis of clinical effect of nursing intervention on strokeassociated pneumonia. Clin Nurs Res. 2019;33(01):22\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12102/j.issn.1009-6493.2019.01.006\u003c/span\u003e\u003cspan address=\"10.12102/j.issn.1009-6493.2019.01.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"multidisciplinary diagnosis and treatment, non-pharmacological airway clearance techniques, stroke-associated pneumonia","lastPublishedDoi":"10.21203/rs.3.rs-6105418/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6105418/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eThis study aims to evaluate the effectiveness of multidisciplinary treatment combined with non-pharmaceutical airway clearance technology in preventing stroke-associated pneumonia, and to provide reference for the prevention and management of stroke- associated pneumonia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quasi-experimental study was conducted at a Grade-A hospital in Siping City, China, from October 2023 to March 2024. A total of 160 stroke patients were recruited and randomly assigned to an intervention group (n\u0026thinsp;=\u0026thinsp;80) or a control group (n\u0026thinsp;=\u0026thinsp;80). 12 patients were excluded due to unstable conditions. The intervention group received multidisciplinary care combined with non-pharmaceutical air passage clearance technology, while the control group received conventional care. Key indicators such as SAP incidence, clinical pulmonary infection scores, intubation days, cure days, and hospital stay length were analyzed using SPSS 27.0.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe incidence of SAP in intervention group was significantly lower than that in control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Clinical pulmonary infection score of the intervention group was significantly lower than that of the control group following the intervention(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049). The impact of the intervention on pulmonary infection scores varied significantly across different time points (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, the effects of the intervention on PaO\u003csub\u003e2\u003c/sub\u003e and PaCO\u003csub\u003e2\u003c/sub\u003e varied significantly over times (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, the intervention group exhibited significantly reduced tracheal intubation durations, days to cure, and hospital stay lengths compared to the control group. (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) However, there was no statistically significant difference in hospitalization costs between the two groups(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.539).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study demonstrated that a multidisciplinary intervention combined with non-pharmacological airway clearance techniques significantly reduced the incidence of pneumonia and improved clinical outcomes in stroke patients. Future research should focus on the cost-effectiveness of these interventions and their long-term impact on patient recovery.\u003c/p\u003e","manuscriptTitle":"Multidisciplinary Treatment Combined with Non-Pharmacological Airway Clearance Techniques for Preventing Stroke-Associated Pneumonia: A Quasi-Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-04 08:48:09","doi":"10.21203/rs.3.rs-6105418/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"799999fd-cb07-4df7-840d-a7861242483a","owner":[],"postedDate":"March 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-17T11:08:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-04 08:48:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6105418","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6105418","identity":"rs-6105418","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}