The role of T-tubes in the management of airway stenosis

Eur J Cardiothorac Surg. 2013 May;43(5):934-9. doi: 10.1093/ejcts/ezs514. Epub 2012 Sep 18.

Abstract

Objectives: When the T-tube is inserted as a temporary stent, it is unclear whether keeping it longer in place has any benefit on the outcome.

Methods: Among 1738 patients with airway stenosis (1996-2011), 134 underwent T-tube placement (mean duration = 14.3 months); temporarily while waiting for an appropriate time for surgery in 53 (Group 1), as an adjunct after a complex laryngotracheal resection in 27 (Group 2), after surgical failure in 43 (Group 3) and permanently in 11 unresectable strictures (Group 4). A logistic regression model was used for statistical analysis.

Results: Seventy percent of patients were males (age = 33.6 ± 17 years). The main cause was postintubation/post-tracheostomy stenosis in 87% of patients. The stenosis (29.6 ± 14 mm, 5-80 mm) was located in the subglottis in 33%, trachea in 47% and both in 20% of cases. To assess the effect of T-tubes on stabilizing the airway after decannulation, 50 patients who still had a T-tube at the end of follow-up or for <1.5 months were excluded. Of the remaining 84, 31.5, 91.5 and 32.5% of patients in Groups 1, 2 and 3 were stable at least 3 months after decannulation. Moreover, 70% of those who were decannulated at or before 6 months and 53.7% of those who were decannulated after 6 months underwent another intervention (P = 0.17). The age, sex, cause, site of stenosis and even duration of T-tube insertion (P = 0.07) showed no significant effect on the decannulation outcome.

Conclusions: Although it seems that keeping the T-tube in place for >6 months may increase the chance of successful decannulation, it was not confirmed in our study.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Airway Extubation / instrumentation
  • Airway Extubation / methods
  • Airway Management / instrumentation*
  • Airway Management / methods*
  • Chi-Square Distribution
  • Child
  • Device Removal
  • Female
  • Humans
  • Intubation, Intratracheal / instrumentation
  • Intubation, Intratracheal / methods
  • Logistic Models
  • Male
  • Middle Aged
  • Risk Factors
  • Stents*
  • Tracheal Stenosis / prevention & control
  • Tracheal Stenosis / therapy*
  • Tracheostomy / instrumentation
  • Tracheostomy / methods
  • Treatment Outcome