Analysis of PICU management and follow-up after Montgomery T-tube placement in children
杜岩 1谭乐恬 2刘盼 1杜俐佳 1柳宇鑫 1陶金好 1陈超 2张铮铮 1陆国平 1陈伟明 1林楠
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作者信息
1. 复旦大学附属儿科医院重症医学科，上海 201102
2. 复旦大学附属儿科医院耳鼻咽喉科，上海 201102
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摘要
目的 通过对置入Montgomery T管重症患儿的临床情况进行分析及随访，总结T管置入术后PICU监护管理的经验及T管在重症儿童应用的效果。 方法 对2019年4月至2021年12月复旦大学附属儿科医院收治的7例Montgomery T管置入术后患儿的病因、临床特点、并发症、ICU住院情况及长期随访情况进行分析，结合临床经验，对T管在病情危重、需要接受长期机械通气患儿中的应用加以阐述。 结果 研究期间纳入了7例置入T管术后入住PICU的患儿，男3例，女4例，年龄9~75个月，5例患儿接受机械通气治疗。其中喉先天性畸形5例，气管食管瘘1例，喉乳头状瘤1例。主要并发症为痰液堵塞、感染及肉芽增生。1例患儿出现分泌物堵塞死亡，其余患儿均成功撤离T管，T管最长留滞时间367 d，5例患儿拔除T管后出现声嘶。6例存活患儿出院后生活质量较术前提高，均恢复经口进食，门诊随访未诉吞咽困难及误吸,但均合并营养不良。 结论 Montgomery T管是一种安全可靠的气道支架，可用于气道重塑以及维持介入术后气道的通畅；对于儿童重症患者，做好早期气道廓清及抗感染等管理至关重要。 Objective To analyze the clinical situation of critically ill children with Montgomery T-tube，aiming to summarize the characteristics of T-tube application in pediatric and the experience of postoperative airway management in PICU. Methods The etiology，clinical characteristics，complications and ICU admissions of patients with Montgomery T-tube admitted to the Pediatric Hospital of Fudan University from April 2019 to December 2021 were analyzed，and the application of T-tube in patients with critical conditions requiring long-term mechanical ventilation was described in the light of clinical experience. Results During the study period,seven children were admitted to the PICU after T-tube insertion,including three males and four females,aged 9~75 months.Five children received mechanical ventilation.Among them,there were five cases with congenital laryngeal malformations,one case with tracheoesophageal fistula,and one case with laryngeal papilloma.The main complications were sputum blockage,infection,and granulation proliferation.One child died of secretion blockage,while the other children were successfully evacuated from the T-tube.The longest retention time of the T-tube was 367 days.Five patients experienced hoarseness after removing the T-tube,and upon re-examination with fiberoptic bronchoscopy,no recurrence of subglottic stenosis was observed.There was no respiratory distress or wheezing,and there were no abnormalities observed during regular outpatient follow-up after discharge.After discharge,the quality of life of the six surviving children improved compared to preoperative,and they all resumed oral feeding.There were no complaints of swallowing difficulties or aspiration during outpatient follow-up.But they were all combined with malnutrition. Conclusion The Montgomery T-tube is a secure and dependable airway stent utilized for airway remodeling and the maintenance of airway patency following interventional surgery.For critically ill children,early management of airway clearance and infection prevention are imperative.
Abstract
Objective To analyze the clinical situation of critically ill children with Montgomery T-tube，aiming to summarize the characteristics of T-tube application in pediatric and the experience of postoperative airway management in PICU. Methods The etiology，clinical characteristics，complications and ICU admissions of patients with Montgomery T-tube admitted to the Pediatric Hospital of Fudan University from April 2019 to December 2021 were analyzed，and the application of T-tube in patients with critical conditions requiring long-term mechanical ventilation was described in the light of clinical experience. Results During the study period,seven children were admitted to the PICU after T-tube insertion,including three males and four females,aged 9~75 months.Five children received mechanical ventilation.Among them,there were five cases with congenital laryngeal malformations,one case with tracheoesophageal fistula,and one case with laryngeal papilloma.The main complications were sputum blockage,infection,and granulation proliferation.One child died of secretion blockage,while the other children were successfully evacuated from the T-tube.The longest retention time of the T-tube was 367 days.Five patients experienced hoarseness after removing the T-tube,and upon re-examination with fiberoptic bronchoscopy,no recurrence of subglottic stenosis was observed.There was no respiratory distress or wheezing,and there were no abnormalities observed during regular outpatient follow-up after discharge.After discharge,the quality of life of the six surviving children improved compared to preoperative,and they all resumed oral feeding.There were no complaints of swallowing difficulties or aspiration during outpatient follow-up.But they were all combined with malnutrition. Conclusion The Montgomery T-tube is a secure and dependable airway stent utilized for airway remodeling and the maintenance of airway patency following interventional surgery.For critically ill children,early management of airway clearance and infection prevention are imperative.
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