Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Nakwan, Narongwit

doi:10.1378/chest.1822271

Cited by 4 publications

(6 citation statements)

References 3 publications

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“…Subsequently, OFTP was described in adults and children who were intubated for a variety of indications, including acute respiratory failure, airway protection, and others. 5,6,10,31 The most common symptoms consist of hoarseness of voice, stridor, or respiratory failure that can occur either immediately or after a few hours to days. Most of these symptoms are nonspecific and can also be seen in laryngeal edema and/or cord paralysis.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7]22 Due to missed diagnosis, patients generally receive supportive care in the form of nebulized bronchodilators (salbutamol, adrenaline) and corticosteroids (both systemic and inhaled) or re-intubation before correct diagnosis. [4][5][6][7][8]21,31 There is considerable delay in the diagnosis, which can have unfavorable outcomes, including mortality reported in a case with missed diagnosis. 5 In a systematic review comprising 24 subjects, 96.3% of the subjects were symptomatic; the symptoms generally appeared immediately after extubation but could be delayed as long as 70 d after extubation.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous expectoration of the membrane was seen in 6 subjects (5 adults, one child). 9,21,26,28,31 Recurrence of symptoms and repeated formation of the tracheal membrane was encountered in 2 subjects (both adults). 4 There were 2 deaths (one each in adult and pediatric subjects): One was due to progression of sepsis, and in another subject, tracheal pseudomembrane was not identified premortem.…”

Section: Management Of Oftpmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Management Of Oftpmentioning

confidence: 99%

See 1 more Smart Citation

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

Sehgal¹,

Dhooria²,

Bal

et al. 2016

Respir Care

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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 .…”

mentioning

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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“…2 , 8 For those cases that develop secondary to intubation, it has been postulated that hyper-pressure at the site of endotracheal cuff leads to necrosis of the tracheal mucosa and submucosa with subsequent exposure of the cartilage, chondritis and perichondritis. 1 , 10 – 13 …”

Section: Discussionmentioning

confidence: 99%

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

Kwong¹,

Fry²,

Birnie³

2020

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 6-year-old female spayed Ragdoll presented with a 4-day history of acute onset non-productive retching, coughing and anorexia. A complete blood count, serum biochemistry, thoracic radiography and abdominal ultrasound were performed. Initially, aspiration pneumonia was suspected owing to an alveolar lung pattern in the right cranial ventral lung lobes seen on radiographs. The cat did not improve with empirical antibiotic therapy. Bronchoscopy and bronchoalveolar lavage were performed. An intraluminal tracheal mass was identified and removed via endoscopic guidance and gentle traction. Histopathology results were consistent with a fibrinous tracheal pseudomembrane. The cat was concurrently diagnosed with Pseudomonas aeruginosa pneumonia, which was confirmed on bronchoalveolar lavage. Pseudomonas aeruginosa was also cultured within the pseudomembrane. The cat was received antimicrobial therapy for his Pseudomonas pneumonia. In humans, fibrinous tracheal pseudomembranes occur uncommonly as a complication following endotracheal intubation and rarely due to infectious organisms. As there was no prior history of endotracheal intubation, the development of fibrinous tracheal pseudomembrane in this cat was suspected to be secondary to Pseudonomas aeruginosa aspiration pneumonia. Relevance and novel information The present case report is the first to describe a tracheal pseudomembrane in a cat. Bronchoscopy-guided gentle traction and subsequent removal of the tracheal pseudomembrane resulted in a complete resolution of the clinical signs.

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Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Cited by 4 publications

References 3 publications

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

Recurrent Obstructive Fibrinous Tracheal Pseudomembranes in a Young English Bulldog

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

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