Subacute airway obstruction from a tracheal mucosal flap

Abstract

SummaryWe report the case of a 15-year-old girl with a near fatal obstructive tracheal lesion following tracheal intubation. The patient developed stridor and acute respiratory distress 29 h following tracheal extubation, after 35 h intubation in the intensive care unit. The failure of conventional management of stridor, including re-intubation, to provide a satisfactory airway prompted an urgent bronchoscopy, which revealed a tracheal mucosal flap causing 80% obstruction of the subglottic trachea. The fibreoptic bronchoscope allowed careful placement of a tracheal tube distal to the obstruction. The patient eventually made a full recovery. The low incidence of similar lesions and the lack of distinguishing clinical features from other causes of post-extubation stridor make diagnosis and appropriate management of this life-threatening condition difficult. We discuss how early consideration of the diagnosis and optimal initial management reduce the risk of an adverse outcome.

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

“…4,[10][11][12][13] However, in a few other cases, the membrane was located in the mid-trachea, the distal trachea, or the entire length of the trachea. 6,8,14,24 Another theory suggests OFTP to be the first step in the development of tracheal stenosis resulting from ischemic necrosis of tracheal mucosa and submucosa due to inflated endotracheal cuff. 5 However, this logic cannot explain the development of OFTP in subjects where uncuffed endotracheal tubes or high-volume low pressure tubes were used.…”

Akute subglottische Trachealstenose nach Reanimation

“…3 h bis 9 Tage nach Extubation (bei einer Intubationsdauer von 14 h bis 17 Tagen) klinisch manifest wurden [3,5]. Allen Fällen gemeinsam ist das akute Auftreten einer lebensbedrohlichen Situation mit der Notwendigkeit zur Reintubation bzw.…”

Kinking of an endotracheal tube within the trachea: a rare cause of endotracheal tube obstruction

“…There are many causes of ETT obstruction, including kinking, tube defects, foreign body obstruction, secretions, tracheal mucosal flaps, stylet sheering, blood clots, and even parasitic infections [1][2][3][4][5]. These causes of obstruction must be distinguished from other causes of difficult ventilation such as bronchospasm, pneumothorax, chest wall rigidity, and equipment malfunction.…”