I think I'm one of the only people in my service who has used an NPA in the past year. And I've used several. What I was taught in the Army is that if they might need it, give it. If they decide they don't want it, they'll take it out themselves. If they can't remove it, they probably needed it...
While I know how to use an NPA, I've only ever had to use one a few times. It's just that most of my patients were able to demonstratably keep their airway patent, or they were so far down that they took an OPA... which makes me start reaching for the ETT. I look at airway patency first, then if unable to maintain their airway, I reach for the OPA. If the patient tolerates it, I seriously consider ETT. If not and the patient still can't keep a patent airway, I'll reach for the NPA. If the airway patency is marginal and I don't think they'll take an OPA, then I'll go for the NPA first.
I use NPAs pretty frequently. I go for them first over OPAs because in my experience they are super quick to place and hard to dislodge accidentally. In fact if I'm worried about the airway I'll just pop 2 in. They're great pre ETT as well because they won't get in the way and will keep the airway patent throughout.
