Indications and outcomes for use of montgomery cannulas

Abstract

IMPORTANCE: To our knowledge, we report the first series to analyze use of the Montgomery cannula as an airway management tool for indications other than obstructive sleep apnea. OBJECTIVES: To analyze the use and outcomes of Montgomery cannula placement for airway management and to identify indications for placement. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of 20 patients who received a Montgomery cannula from 2003 through 2012 at the University of Iowa Hospitals and Clinics. INTERVENTION: Montgomery cannula placement. MAIN OUTCOMES AND MEASURES: Indications for cannula placement, comorbidities, body mass index, reasons for failure of cannula use, and complications. RESULTS: Indications included glottic stenosis (n = 7), obstructive sleep apnea (n = 5), bilateral vocal cord paralysis (n = 4), subglottic stenosis (n = 4), supraglottic swelling after radiation or chemoradiation therapy (n = 4), bulbar dystonia with paradoxical vocal cord motion (n = 1), vocal cord fixation secondary to rheumatoid arthritis and gastroesophageal reflux disease (n = 1), and airway obstruction associated with seizure disorder (n = 1). Comorbidities included obesity or overweight (n = 14), gastroesophageal reflux disease (n = 9), hypertension (n = 7), and diabetes mellitus (n = 6). Fifteen patients successfully used a Montgomery cannula, including all patients with 3 or fewer comorbidities. Five patients required replacement with a Jackson tracheostomy tube due to persistent tracheostomal granulation tissue (n = 2), feeling safer with the tracheostomy tube (n = 1), a posterior scar band causing airway obstruction (n = 1), and inability to care for the cannula because of poor manual dexterity from arthritis (n = 1). The mean (range) body mass index of successful and unsuccessful users was 27.5 (18.2-37.7) and 33.8 (24.1-42.7), respectively. Complications included the cannula being blocked by adipose tissue (n = 2) or pushed posteriorly into the airway (n = 2). The Montgomery cannula was used as a successful decannulation tool in 4 patients-with the cannula serving as an interim airway management tool leading to tracheostome closure. CONCLUSIONS AND RELEVANCE: We identified features associated with successful use of the cannula and an additional indication for a Montgomery cannula asa step-down management tool for decannulation.