Obstructive Fibrinous Tracheal Pseudomembrane

Abstract

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a relatively rare cause of failed extubation. OFTP may be more common than described in the literature. OFTP results from ischemic injury to tracheal mucosa and may be the initial stage of the development of tracheal stenosis. Early diagnosis and treatment can prevent re intubation and mortality. We present a rare case of OFTP. The patient was intubated for 3 days for asthma exacerbation and was appropriately discharged. The patient was seen the second time in the emergency room and was treated for asthma exacerbation on the same day. Because of persistent symptoms after 3 days, CT scan of the chest was performed, which indicated necrotizing tracheitis with gas formation within the tracheal wall. Bronchoscopy showed no evidence of necrosis, but there was a thick white plaque toughly adherent to the tracheal wall.

Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway

“…When the capillary perfusion pressure increases to over 18–25 mmHg, mechanical edema and ischemia of the tracheal mucosa [4] could cause mucosal necrosis and erosions, which subsequently lead to the formation of a fibrous granuloma or scar in the tracheal mucosa. Indeed, a membranous flap-like morphology in tracheal obstructions has been described frequently in patients with a history of prolonged intubation or tracheostomy [5], [6], [7], [8], [9], [10], [11], [12]. In the absence of a history of tracheal intubation, we suspect that self-induced vomiting was the cause of our patient's tracheal irritation and membranous tracheal stenosis.…”

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.…”