Risk Factors for Complications After Montgomery T-Tube Placement in Benign Tracheal Stenosis: Results from a Prospective Study.

Abstract

Montgomery T-tubes are used to manage benign tracheal stenosis in patients unfit for surgical resection. While effective in maintaining airway patency, their use is often complicated by adverse events with unclear predictors. The main objective of this study was to define predictors for unplanned airway interventions after T-tube placement in patients with postintubation tracheal stenosis. This prospective cohort study included patients with symptomatic benign tracheal stenosis. All patients underwent placement of a Montgomery T-tube between July 2018 and December 2022. We evaluated predictors of unplanned airway interventions, global complications, unplanned intensive care unit admission, and the decannulation rate. Univariate and multivariate logistic regression analyses were performed. The alpha level was set at 0.05. A total of 153 patients underwent 260 endoscopic procedures. Independent predictors of unplanned interventions included age >60 years (odds ratio [OR], 0.89; 95% CI, 0.864-0.920; P < .001), body mass index >30 kg/m² (OR, 3.73; 95% CI, 1.05-13.23; P = .041), and distance between vocal cords to the stenosis ≤5mm (OR, 7.71; 95% CI, 2.27-26.23; P = .001) or 6-10 mm (OR, 30.55; 95% CI, 5.97-156.15; P < .001). Transglottic T-tube placement was associated with higher complication rate when compared with infraglottic position (23% vs 12%; P = .04) and increased unplanned intensive care unit admissions (OR, 8.56; 95% CI, 1.35-54.12; P = .022). The overall decannulation rate was 28%. Obesity and short distance between stenosis and the vocal cords are significant predictors of adverse outcomes after Montgomery T-tube placement. Transglottic positioning of the T-tube markedly increases the risk of complications and unplanned intensive care unit admissions.