The Montgomery T-tube in terminal care

The use of a Montgomery T-tube as a palliative measure in the treatment of patients with respiratory obstruction due to cancer is described.

Six patients with terminal malignant disease presented with airway obstruction caused by direct infiltration of the trachea by tumor. The primary carcinoma originated in the esophagus in five cases, whereas one patient had metastatic carcinoma of the breast. In each case, the airway was initially secured using a rigid ventilating bronchoscope that was advanced past the area of tracheal obstruction. Tumor was removed from the lumen of the bronchoscope with suction and cup forceps. Anesthesia was continued through the bronchoscope while the trachea was exposed through a cervical incision and a window cut in the anterior tracheal wall. A Montgomery T-tube was inserted as the bronchoscope was withdrawn.

This technique allowed dramatic relief of airway obstruction in all cases. The tube relieves the obstruction by stenting the airway and permits speech in most patients. The authors stress the need for frank discussion with patients and family when considering the appropriateness for this form of palliation.