Postintubation Obstructive Pseudomembrane

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

“…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. 8,18 In the illustrative case presented in the current study, the child developed stridor immediately after extubation and required re-intubation; there was a delay in making the correct diagnosis by 10 d. The exact etiopathogenesis of OFTP remains unknown, and various hypotheses have been postulated. The subglottic area is the narrowest part of the larynx that is completely surrounded by the cricoid cartilage that forms a rigid circle.…”

“…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.…”

“…[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.…”

“…[5][6][7] Treatment involves confirmation by flexible bronchoscopy and removal of the membrane using either rigid or flexible bronchoscopy. [6][7][8] Herein, we present an illustrative case and perform a systematic review of literature on obstructive tracheal pseudomembrane that complicates tracheal intubation.…”

Pediatric obstructive fibrinous tracheal pseudomembrane—Characteristics and management with flexible bronchoscopy

“…It has previously been reported in only 14 adults [4][5][6][7] and 5 pediatric [8][9][10][11] patients. Among them, 2 adult patients died from this airway obstruction.…”