Obstructive Fibrinous Tracheal Pseudomembrane

Rice, Brenda L.; Culver, Daniel A.; Santacruz, Jose F.; Lazar, Catherine A.; McCarthy, Kevin; Gildea, Thomas R.

doi:10.1016/j.athoracsur.2011.05.099

Cited by 12 publications

(5 citation statements)

References 5 publications

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“…Onset of respiratory distress in OFTP varies, ranging from within the first hour to 14 d after extubation. 3,[5][6][7][8][9] The type of ETT may directly affect development of OFTP; however, we have no explanation as to why OFTP still occurred in our subject despite the fact that a low-pressure high-volume cuff was used in conjunction with intensive monitoring of cuff pressure.…”

Section: Discussionmentioning

confidence: 73%

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Nakwan

2013

Respir Care

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Obstructive fibrinous tracheal pseudomembrane (OFTP) is an airway complication that occurs after endotracheal intubation. It originates from superficial mucosal abrasion and desquamation of necrotic tracheal epithelium at the site of cuff pressure. This condition is a rare cause of postextubation stridor. We present a case of postextubation stridor secondary to OFTP, resulting in clinical features of upper airway obstruction > 8 h after extubation. The case features complete obstruction at the tip of the endotracheal tube from OFTP.

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Section: Discussionmentioning

confidence: 73%

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Nakwan

2013

Respir Care

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“…In one subject each, tracheostomy and electrocautery with snaring was performed during rigid bronchoscopy to relieve the symptoms. 9,23 Rigid bronchoscopy was used more frequently to relieve the airway obstruction in adults (56.4%), whereas flexible bronchoscopy was used more often in pediatric subjects (60%). Spontaneous expectoration of the membrane was seen in 6 subjects (5 adults, one child).…”

Section: Management Of Oftpmentioning

confidence: 99%

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

Sehgal¹,

Dhooria²,

Bal

et al. 2016

Respir Care

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Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the PubMed and EmBase databases for all the cases describing OFTP. The systematic search yielded 28 citations describing 53 subjects with OFTP. The study population (61.1% females) comprised of both adults and pediatric subjects with a median (IQR) age of 40.5 (14.8 -60.5) years. The median (IQR) size of endotracheal tube was 7.5 (6 -9.3) mm with a median (IQR) duration of intubation of 36 (14 -96) hours. The median (IQR) time to onset of symptoms after extubation was 24 (6 -96) hours. Stridor was the most common symptom. The average delay in correctly identifying the OFTP was 26 hours. The diagnosis of tracheal pseudomembrane was confirmed by flexible bronchoscopy in 38 (70.4%) instances while rigid bronchoscopy was used in 46.3% subjects for removing the pseudomembrane. There were two deaths, one each in an adult and a pediatric subject. OFTP is a complication of tracheal intubation and presents with respiratory failure. The diagnosis can be confirmed by flexible bronchoscopy. Treatment involves removal of the obstructing membrane with either flexible or rigid bronchoscopy.

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“…Indeed, 3 episodes of respiratory distress that required endoscopic intervention to relieve airway obstruction occurred. In birds, in which postintubation tracheal pseudomembranes are also recognized, and in humans, mechanical ablation of the lesion typically leads to full recovery without relapse . Experimental models in rabbits suggest that the same tissue reaction and subsequent tracheal obstruction can be seen not only with endotracheal cuff‐related injuries but also with trauma or irritation of the tracheal mucosa without pressure necrosis .…”

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confidence: 99%

Recurrent Obstructive Fibrinous Tracheal Pseudomembranes in a Young English Bulldog

Robin

Guieu

Boedec

2017

Veterinary Internal Medicne

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Endotracheal intubation is a common procedure, rarely associated with life‐threatening complications (e.g., tracheal rupture, necrosis, foreign body). A 1.5‐year‐old English Bulldog was presented for respiratory distress, with increased respiratory efforts and stridor, 2 days after endotracheal intubation. Cervical and thoracic radiographs disclosed a severe narrowing of the tracheal lumen associated with an intraluminal soft‐tissue structure at the thoracic inlet. Tracheoscopy confirmed the presence of an obstructive fibrinous tracheal pseudomembrane (OFTP) creating a 1‐way valve obstruction. Removal of the OFTP dramatically improved the dog's respiratory function, but the lesion reformed twice despite corticosteroid and antibiotic therapy PO, warranting repeated endoscopic removal of the OFTP. No additional recurrences were observed after treatment with inhaled heparin and N‐acetylcysteine q4h. No respiratory signs were reported 9 months after discharge. Postintubation OFTP has been reported rarely in humans and never described in dogs. Unexplained signs of upper airway obstruction shortly after endotracheal intubation should prompt consideration of OFTP in dogs, even if intubation was uneventful. Unlike its counterpart in humans, OFTP in dogs can reoccur after endoscopic removal, warranting repeated endoscopic extraction. A combination of corticosteroid therapy PO and heparin and N‐acetylcysteine inhalation q4h may be attempted if recurrence is observed.

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Obstructive Fibrinous Tracheal Pseudomembrane

Cited by 12 publications

References 5 publications

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

Recurrent Obstructive Fibrinous Tracheal Pseudomembranes in a Young English Bulldog

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