Predictive factors for successful decannulation of the Montgomery T-tube in patients with complex airway stenosis during the COVID-19 pandemic at a tertiary hospital in Lima, Peru

Mallqui R.T.; Porcel P.A.; Cuello M.P.; León J.P. · Current Challenges in Thoracic Surgery (2026) · DOI: 10.21037/ccts-2025-1-67

Resumen

Background: The Montgomery T-tube (MTT) is widely utilized for the management of complex airway stenosis; however, there is a lack of standardized clinical criteria and predictive models to determine the optimal timing for successful decannulation. This study aims to identify clinical and anatomical predictive factors for successful decannulation (SDMTT) in patients with complex airway stenosis during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A retrospective cohort study was conducted at the Hospital Nacional Guillermo Almenara Irigoyen (Lima, Peru) between June 2020 and November 2024. Seventy-three patients with laryngotracheal stenosis were included. Evaluated indicators included: tracheostoma level (standardized vs. non-standardized), stenosis length (mm), subglottic involvement, and distal granuloma. Multivariable logistic regression and Kaplan-Meier survival analysis for time-to-decannulation were employed. Results: Seventy-three patients (50±16 years) were analyzed. The successful decannulation rate was 45%. Survival analysis showed a median time to success of 21 months [95% confidence interval (CI): 17.3–31.0]. In the adjusted multivariable analysis, the independent predictors were stenosis length [adjusted odds ratio (aOR): 0.92; 95% CI: 0.88–0.97; P=0.002], subglottic involvement (aOR: 0.20; 95% CI: 0.05–0.78; P=0.02), and distal granuloma (aOR: 0.18; 95% CI: 0.03–0.99; P=0.04). A standardized tracheostoma level showed a strong clinical trend toward success (aOR: 3.29; P=0.055). Conclusions: Stenosis length, subglottic involvement and the presence of distal granuloma are the primary predictors of success. Notably, a standardized tracheostoma level emerged as a key procedural determinant with a substantial clinical effect. While decannulation in these high-complexity cases requires prolonged periods (median 21 months), our robust model [area under the receiver operating characteristic (AUROC) 0.873] demonstrates that success is primarily driven by anatomical and technical factors. © AME Publishing Company.

Instituciones: Universidad Nacional Mayor de San Marcos