Obstructive Fibrinous Tracheal Pseudomembrane

Abstract

Obstructive fibrinous tracheal pseudomembrane is a rare but potentially fatal complication associated with endotracheal intubation. Little is known about the mechanisms that play a role in the development of tracheal pseudomembrane, but it requires early diagnosis and treatment to prevent its major consequences. In this report, we present a case of obstructive fibrinous tracheal pseudomembrane, which developed a day after extubation in a patient who was intubated for 2 days. Therapeutic bronchoscopy was highly successful in removing the lesion and improving the clinical course.

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

“…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.…”

“…However, in most cases, OFTPs are easily removed by bronchoscopy, and patients almost always recover without residual lesions. [7][8][9] In addition to bronchoscopy, chest imaging, particularly chest computed tomography, is also helpful in diagnosing OFTP. 8,9 Occasionally, this condition may be diagnosed by spontaneous expectoration of the OFTP tissue.…”

“…[7][8][9] In addition to bronchoscopy, chest imaging, particularly chest computed tomography, is also helpful in diagnosing OFTP. 8,9 Occasionally, this condition may be diagnosed by spontaneous expectoration of the OFTP tissue. However, prompt recognition of this condition is vital, as management of the patient will be completely altered.…”

Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis

“…Since then, only about 30 cases have been reported worldwide. [2][3][4][5][6][7][8][9] The condition presents clinically as stridor or respiratory insufficiency after extubation. It is certainly difficult to differentiate OFTP from other conditions because laryngeal spasm, edema, and the retention of secretions also present with stridor or respiratory insufficiency.…”

“…Although 4 cases were treated with flexible bronchoscopy, the use of a rigid bronchoscope allows for rapid detachment of the pseudomembrane from the trachea while safely maintaining a patent airway. [1,2,9] Partial detachment of the proximal pseudomembrane during this procedure can induce life-threatening acute respiratory failure due to valve-manner tracheal obstruction. [1] In summary, we described a rare case of OFPT presented with atelectasis in a patient with ESRD maintained on HD.…”