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Verger N, Parpet P, Bentoumi Y, Paulet R, Thyrault M, Sztrymf B. [Acute respiratory distress due to tracheostomy tube migration]. Rev Mal Respir 2024; 41:257-261. [PMID: 38388288 DOI: 10.1016/j.rmr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024]
Abstract
Tracheostomy cannula care is of paramount importance in the daily management of tracheotomized patients. While some complications are commonplace, specific events can occur, often according to type of cannula. We herein report the case of a 71-year-old patient; following a lengthy stay in the intensive care unit, she had received a Safe T-Tube cannula designed to provide support in a stenotic trachea. At home, while suctioning her tracheal secretions, she suddenly experienced respiratory distress requiring a rapid intervention. On arrival, no seeable cannula was found, either in the tracheostomy or in the patient's immediate surroundings. Following her transfer to intensive care, a new cannula was inserted into the tracheostomy opening, enabling mechanical ventilation to begin and achieving rapid relief of dyspnea and improvement of the patient's overall condition. Bronchial fibroscopy was then performed, during which the Safe T-Tube cannula was found folded on itself in a supra-carinal intra-tracheal position. It was extracted and replaced by a cannula of the same model, which was sewn to the skin. Although rare and usually limited to flexible cannulas, this complication is potentially fatal. Generally speaking, when cannula obstruction is suspected, bronchial endoscopy in an intensive care setting is a vital necessity. It is not only the cornerstone of the diagnosis, but also of paramount importance in treatment taking into full account the mechanism of obstruction.
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Affiliation(s)
- N Verger
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France.
| | - P Parpet
- SAMU-SMUR de Longjumeau, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 91160 Longjumeau, France
| | - Y Bentoumi
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
| | - R Paulet
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
| | - M Thyrault
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
| | - B Sztrymf
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
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2
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Feng M, Watson W, Arom G, Damazo B, Krishna P. More Than 1 Way to Put in A T-Tube: A Review of Different Techniques Used in Insertion of Montgomery T-Tubes. Ann Otol Rhinol Laryngol 2024; 133:205-213. [PMID: 37706490 DOI: 10.1177/00034894231198756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The Montgomery T-tube is a commonly used device initially designed as a temporary airway stent, but also used as a long-term airway solution for stenosis. For patients undergoing either endoscopic or open airway procedures, proper techniques for inserting these tubes are well documented. This review compiles the techniques used for insertion of the Montgomery T-tube stent. METHODS The NCBI Pubmed database was queried using the keywords: "stent," "Montgomery," "T-tube," "stenosis," "technique." A total of 33 papers were reviewed with 12 papers selected for the study. Papers were selected based on inclusion criteria of English language and whether the paper described a technique for insertion of a Montgomery T-tube into the airway. Papers were excluded if they did not describe the technique of insertion of Montgomery T-tubes or dealt with another aspect of T-tube management. RESULTS The 12 selected papers each described a different technique for insertion of a Montgomery T-tube stent. Though nearly all the selected studies described using a modified Seldinger technique for insertion of the T-tube, there were discrepancies and a wide array of different instruments used. The instrument and/or technique that was selected was often determined by the individual need of the patient. Several studies addressed the challenge of interrupting ventilation while inserting or exchanging a T-tube in the operating room. These studies described attaching the T-tube to the endotracheal tube to pass the T-tube into the airway while allowing for continuous ventilation. Yet other studies used optical forceps or rigid bronchoscopes to allow placement of the T-tube with direct visualization. CONCLUSION There are many techniques used for the insertion of a Montgomery T-tube. Nearly all studies described using a modified Seldinger technique and all the studies agreed on the necessity of a team approach for placement of the Montgomery T-tube.
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Affiliation(s)
- Max Feng
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - WayAnne Watson
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Gabriel Arom
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Benjamin Damazo
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Priya Krishna
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
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3
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Baguant A, Aboussouan MP, Castellanos PF, Atallah I. Decannulation of Tracheostomy-Dependent Patients: Results and Review of Techniques of Reconstructive Transoral Laser Microsurgery. Ann Otol Rhinol Laryngol 2023; 132:361-370. [PMID: 35686520 DOI: 10.1177/00034894221097183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to demonstrate the benefit of reconstructive transoral laser microsurgery (R-TLM) in decannulation of tracheostomy-dependent patients with airway obstruction. METHODS A consecutive series of tracheostomy-dependent patients who underwent R-TLM using multiple techniques described in our previous works, were reviewed for outcomes especially for decannulation. Full airway examination was essential to determine the anatomical and functional sites of obstruction to establish the surgical plan including R-TLM techniques needed to improve airway prior to permanent decannulation. RESULTS Twenty-two patients were treated. Eighteen subjects were successfully decannulated. Single or multiple R-TLM surgical technique(s) was/were performed during the same surgery to treat upper airway stenosis at the level of the hypopharynx, larynx, and trachea. The mean number of surgeries per patient was 2.1. Patients were followed up for at least 12 months. CONCLUSION R-TLM combines different surgical techniques which can be used individually or combined in a stepwise surgical plan for permanent decannulation of tracheostomy-dependent patients with a previous history of decannulation failure secondary to airway obstruction. Accurate preoperative examination gives valuable information about airway and allows establishing a stepwise surgical plan that may need multiple surgeries for full permanent decannulation of these patients.
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Affiliation(s)
- Ashley Baguant
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie-Pierre Aboussouan
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Ihab Atallah
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France.,School of Medicine, Grenoble Alpes University, Domaine de la Merci, Grenoble, France
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Avasarala SK, Dutau H, Mehta AC. Forbearance with endobronchial stenting: cognisance before conviction. Eur Respir Rev 2023; 32:32/167/220189. [PMID: 36889785 PMCID: PMC10032587 DOI: 10.1183/16000617.0189-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/13/2023] [Indexed: 03/10/2023] Open
Abstract
Endobronchial stenting is an important aspect of the practice of interventional pulmonology. The most common indication for stenting is the management of clinically significant airway stenosis. The list of endobronchial stents available on the market continues to grow. More recently, patient-specific 3D-printed airway stents have been approved for use. Airway stenting should be considered only when all other options have been exhausted. Due to the environment of the airways and the stent-airway wall interactions, stent-related complications are common. Although stents can be placed in various clinical scenarios, they should only be placed in scenarios with proven clinical benefit. The unwarranted placement of a stent can expose the patient to complications with little or no clinical benefit. This article reviews and outlines the key principles of endobronchial stenting and important clinical scenarios in which stenting should be avoided.
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Affiliation(s)
- Sameer K Avasarala
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hervé Dutau
- Thoracic Oncology, Pleural Disease and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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5
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Weissbrod PA, Panuganti B, Yang J, Cheng G. Developing a Tracheal Rendezvous Procedure for Complete High Subglottic Stenosis. Life (Basel) 2023; 13:life13030740. [PMID: 36983895 PMCID: PMC10058324 DOI: 10.3390/life13030740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/20/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Complete subglottic stenosis is often managed with surgical resection. However, involvement of the high subglottis can limit candidacy for open resection, and there are few treatment options for these patients. We refined an endoscopic approach that evolved into a tracheal rendezvous technique with T-tube placement as an alternative to open surgical resection. Here, we present our series, technique, and outcomes. A retrospective review was performed to identify patients who underwent endoscopic management of complete high subglottic stenosis at the University of California San Diego. The surgical technique was initially a two-step staged procedure and was subsequently revised to a single-stage procedure with stenosis ablation, dilation, and insertion of a T-tube, which was completed in one day. Patients were seen at regular follow-up intervals for reassessment. Five patients were identified with complete stenosis not amenable to surgical resection. The average age of the cohort was 44.8 years. The etiology of stenosis in all patients was related to prolonged intubation and tracheostomy, and the average length of stenosis was 19.6 mm. Stenosis resection was accomplished via laser ablation and balloon dilation, and the average T-tube length was 50.3 mm. All patients were discharged on postoperative day one. Two patients developed airway crusting within the T-tube and required emergency department visits. Decannulation was attempted in three patients, although failed in two. Tracheal rendezvous is a safe and effective procedure for patients with grade IV subglottic stenosis. This provides a feasible endoscopic alternative to patients who are not candidates for open surgical resection, ye are motivated to have phonatory capacity.
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Affiliation(s)
- Philip A. Weissbrod
- Department of Otolaryngology, University of California San Diego, La Jolla, CA 92037, USA
- Correspondence: (P.A.W.); (G.C.)
| | - Bharat Panuganti
- Department of Otolaryngology, University of California San Diego, La Jolla, CA 92037, USA
| | - Jenny Yang
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - George Cheng
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA 92037, USA
- Correspondence: (P.A.W.); (G.C.)
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Punj J, Ramkumar R, Sagar P, Pandey R, Darlong V. Keloid presence increases the probability of subglottic tracheal benign stenosis. J Anaesthesiol Clin Pharmacol 2022; 38:662-663. [PMID: 36778799 PMCID: PMC9912890 DOI: 10.4103/joacp.joacp_559_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/30/2021] [Accepted: 06/04/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jyotsna Punj
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Rupavath Ramkumar
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Prem Sagar
- Department of ENT, AIIMS, New Delhi, India
| | - R. Pandey
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Vanlala Darlong
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
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Shakrawal N, Patro SK, Soni K, Kaushal D, Choudhury B, Goyal A. Our Experience with Laryngotracheal Trauma (LTT) in a Tertiary Care Centre of Western Rajasthan. Indian J Otolaryngol Head Neck Surg 2022; 74:375-382. [PMID: 36213471 PMCID: PMC9535059 DOI: 10.1007/s12070-021-02820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022] Open
Abstract
LTT is a life-threatening incident that is fortunately rare. The presenting symptoms might not correlate with the intensity of trauma and range from mild endolaryngeal edema to complete laryngotracheal transection. An early diagnosis and timely intervention is required for successful outcomes and minimizing complications. This retrospective audit was performed on 18 patients of LTT who presented to the emergency from January 2017 to December 2019. The history, clinical presentation, examination findings, degree and nature of trauma, diagnostic modalities, medical and surgical management, and outcomes were analyzed. A total of 13 males and 5 females were included in this audit, with a mean age of 38.7 years. The most common cause was accidental in 77.7% patients. 61.5% of patients presented with Schaefer grade 3 and higher. Out of which 46% underwent emergent neck exploration and repair. 27.7% (5/18) presented with sequelae which were managed either by T- tube stenting, endoscopic dilatation by coblation, or laryngotracheal resection (LTR) and end-to-end anastomosis (EEA). Out of 14 surgically reconstructed airways, successful decannulation was achieved in 57.1% (8) patients. High clinical suspicion, early referral with emergent intervention is paramount for successful outcomes, fewer recurrences, and reduction of hospital's and patient's financial burden as timely planning and intervention can ensure successful decannulation of around two thirds of the higher grades (grade 3-5) of laryngotracheal traumatic injuries. Early airway establishment is the most critical goal. Definitive treatment protocols are needed in this field which warrants further formulation of multicentric studies and audits.
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Affiliation(s)
- Neha Shakrawal
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
- Dept of Oto-Rhino-Laryngology, SNMC, Jodhpur, India
| | - Sourabha K. Patro
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
- Dept of Otolaryngology & Head and Neck Surgery, PGIMER, Sector-12, Chandigarh, 160012 India
| | - Kapil Soni
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
| | - Darwin Kaushal
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
- Dept of Oto-Rhino-Laryngology, AIIMS, Bilaspur, India
| | | | - Amit Goyal
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
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8
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Surgical and Anaesthetic Challenges Faced During Successful Management of a Complex Tracheal Injury Using Montgomery T Tube in a Zonal Hospital. Indian J Surg 2022; 85:465-467. [PMID: 35529245 PMCID: PMC9058742 DOI: 10.1007/s12262-022-03428-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
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9
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Gupta P, Gupta M. In situ remodeling of Montgomery T-tube: Anesthetic challenges and serendipitous discoveries. J Anaesthesiol Clin Pharmacol 2022; 38:493-494. [PMID: 36505215 PMCID: PMC9728427 DOI: 10.4103/joacp.joacp_445_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/07/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Priyanka Gupta
- Department of Anaesthesia, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Mayank Gupta
- Department of Anaesthesia, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India,Address for correspondence: Dr. Mayank Gupta, Department of Anaesthesia, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand - 248 001, India. E-mail:
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10
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Application of Montgomery T-Tube Placement in Treating Cotton-Myer IV Subglottic Airway Atresia after Bi-Level Airway Recanalization. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5517536. [PMID: 34135990 PMCID: PMC8177995 DOI: 10.1155/2021/5517536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
Objective The purpose of this study is to explore the effectiveness and safety of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization. Methods This study is a retrospective study. 11 patients who were treated for IV subglottic airway atresia between January 2017 and January 2019 in the Second Affiliated Hospital of Jiaxing University were involved in this study. The 11 patients all had undergone tracheotomies at our hospital, and they were transferred to the Department of Pulmonary and Critical Care Medicine for Montgomery T-tube placement after bi-level airway recanalization when their subglottic airway was atretic. Patients were observed for their clinical manifestations after placement. The effectiveness of T-tube placement after bi-level airway recanalization was assessed. The incidence of short-term and long-term complications after surgery was assessed. Patients were followed up for 3 to 24 months for evaluating their airway recovery. Results T-tubes were successfully placed in 11 patients. The atretic airways of all patients were recanalized after treatment. Eight patients got restoration of vocal ability, and 3 patients could only say simple words. None of the patients needed assisted oxygen inhalation. The SpO2 average level was increased from 95 ± 2% before treatment to 97 ± 3% after treatment. Patients had significant relief of cough or sputum, and they had less difficulty in dyspnea. All short- or long-term complications were self-relieved or controlled without further malignant progression after treatment by doctors. The average postoperative extubating time was (14.86 ± 3.62) months. Conclusion The application of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization is well effective and safe for patients, and it can be promoted in clinical treatment.
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11
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Rosero EB, Corbett J, Mau T, Joshi GP. Intraoperative Airway Management Considerations for Adult Patients Presenting With Tracheostomy: A Narrative Review. Anesth Analg 2021; 132:1003-1011. [PMID: 33369928 DOI: 10.1213/ane.0000000000005330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tracheotomy is a surgical procedure through which a tracheostomy, an opening into the trachea, is created. Indications for tracheostomy include facilitation of airway management during prolonged mechanical ventilation, treatment of acute upper airway obstruction when tracheal intubation is unfeasible, management of chronic upper airway obstructive conditions, and planned airway management for major head and neck surgery. Patients who have a recent or long-term tracheostomy may present for a variety of surgical or diagnostic procedures performed under general anesthesia or sedation/analgesia. Airway management of these patients can be challenging and should be planned ahead of time. Anesthesia personnel should be familiar with the different components of cuffed and uncuffed tracheostomy devices and their connectivity to the anesthesia circuits. An appropriate airway management plan should take into account the indication of the tracheostomy, the maturity status of the stoma, the type and size of tracheostomy tube, the expected patient positioning, and presence of patient's concurrent health conditions. Management of the patient with a T-tube is highlighted. Importantly, there is a need for multidisciplinary care involving anesthesiologists, surgical specialists, and perioperative nurses. The aim of this narrative review is to discuss the anesthesia care of patients with a tracheostomy. Key aspects on relevant tracheal anatomy, tracheostomy tubes/devices, alternatives of airway management, and possible complications related to tracheostomy are summarized with a recommendation for an algorithm to manage intraoperative tracheostomy tube dislodgement.
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Affiliation(s)
- Eric B Rosero
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - John Corbett
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Girish P Joshi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
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12
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Jin B, Wang T, Wang Y, Zhang J. Montgomery T-Tube Insertion Under ECMO in a Patient With Complete Subglottic Stenosis and Severe Lower Tracheal Collapse. EAR, NOSE & THROAT JOURNAL 2021; 102:NP223-NP225. [PMID: 33764200 DOI: 10.1177/01455613211006010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The treatment of complete subglottic stenosis (SGS) remains a challenge due to anatomic and technological limitations. Placement of the Montgomery T-tube is an effective treatment option. For complete SGS patient combined with lower trachea collapse, the ventilation management during the T-tube insertion process is more complicated. Here, we report a case with complete SGS combined with severe lower trachea collapse, which was successfully managed with T-tube insertion under extracorporeal membrane oxygenation.
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Affiliation(s)
- Beibei Jin
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
| | - Yuling Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
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13
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Lakshmi J, Senthil Nathan SM. Anaesthetic management of a patient with Montgomery T-tube in situ for T-tube removal. Indian J Anaesth 2020; 64:825-826. [PMID: 33162589 PMCID: PMC7641066 DOI: 10.4103/ija.ija_293_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/12/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- J Lakshmi
- Department of Anaesthesia, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - S M Senthil Nathan
- Department of Anaesthesia, Coimbatore Medical College and Hospitals, Coimbatore, Tamil Nadu, India
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14
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Margallo Iribarnegaray J, García Luján R, Pina Maíquez I, Revuelta Salgado F, Alfaro Abreu J, de Miguel Poch E. Montgomery T-Tube in the Treatment of Tracheal Stenosis: Experience of a Respiratory Endoscopy Unit and Review of the Literature. Arch Bronconeumol 2020; 57:70-71. [PMID: 32798008 DOI: 10.1016/j.arbres.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Ricardo García Luján
- Departamento de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Isabel Pina Maíquez
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - José Alfaro Abreu
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
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15
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Starostin AV, Berikkhanov ZG, Parshin AV, Amangeldiev DM. [Etiology, diagnosis and treatment of cicatricial tracheal stenosis]. Khirurgiia (Mosk) 2020:53-60. [PMID: 32352669 DOI: 10.17116/hirurgia202004153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.
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Affiliation(s)
- A V Starostin
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - Z G Berikkhanov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - D M Amangeldiev
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
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16
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Tsai SCS, Lin FCF. Surgical treatments for post-intubation laryngotracheal stenosis in patients with central nervous system injuries. Medicine (Baltimore) 2020; 99:e18628. [PMID: 32011442 PMCID: PMC7220156 DOI: 10.1097/md.0000000000018628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.
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Affiliation(s)
- Stella Chin-Shaw Tsai
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital
- Department of Nutrition, Providence University
| | - Frank Cheau-Feng Lin
- School of Medicine, Chung Shan Medical University
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
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Fiorelli A, Natale G, Freda C, Cascone R, Carlucci A, Costanzo S, Ferrara V, Santini M. Montgomery T‐tube for management of tracheomalacia: Impact on voice‐related quality of life. CLINICAL RESPIRATORY JOURNAL 2019; 14:40-46. [DOI: 10.1111/crj.13098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 09/03/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
| | - Giovanni Natale
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
| | - Chiara Freda
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
| | - Roberto Cascone
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
| | - Annalisa Carlucci
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
| | - Saveria Costanzo
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
| | - Vincenzo Ferrara
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
| | - Mario Santini
- Thoracic Surgery Unit Università della Campania Luigi Vanvitelli Naples Italy
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