A simplified approach for the management of post-intubation tracheal stenosis

Abstract

The incidence of post-intubation tracheal stenosis is increasing due to a considerable increase in the number of intensive care units. In this study, we present our experience and outcomes following the use of a “Montgomery T-tube” in patients with post-intubation tracheal stenosis. This is a single center study of 110 patients of post-intubation (endotracheal/tracheostomy) tracheal stenosis from 1998 to 2015. There were 75 males and 35 females. Age ranged between 8 and 75 years (mean 44.94 years). The subglottic stenosis was present in 70 cases and the tracheal (body) stenosis in 40 cases. Eight patients had associated tracheoesophageal fistula (TOF). The most common presentations were the persistent cough and the exercise stridor. All patients underwent preoperative diagnostic workup which included X-ray soft tissue neck lateral view. CT scan of the neck was done in all patients to assess the extent of the lesion. After anesthetic evaluation, all patients underwent rigid bronchoscopy under local anesthesia in operation theatre and the lesion was assessed, if necessary dilatation was undertaken. Total intravenous anesthesia was the preferred anesthetic method. The tracheal T-tube (Montgomery T) stenting was through an external approach under local anesthesia. The follow-up period ranged from 2 to 12 years (mean 5.66 years). The tracheal T-stent was removed after a minimum period of 10–18 months. We had two mortalities unrelated to the procedure. There were no procedure-related complications. Two patients required reinsertion of the tube. Two patients were lost for follow-up. The use of Montgomery T-tube for the post-intubation tracheal stenosis is less time-consuming, cost-effective, associated with less morbidity and mortality, and can be done even in a general hospital setup.