Postintubation Tracheal Web

Difficult intubation due to undiagnosed congenital tracheal web

“…Other manifestations include stridor, dyspnea, use of accessory respiratory muscles and even failure to thrive in infants [1,2,3]. In adults tracheal webs are commonly a consequence of traumatic or prolonged endotracheal intubation [4,5].…”

Tracheal Web

“…Those patients were reported to have unexpected difficulty during intubation while undergoing an operation for an unrelated reason. [4][5][6] However, most of the patients with webs presented with symptoms including frequent episodes of respiratory infections, dyspnea on exertion, wheezing, stridor, severe respiratory distress, and even death depending on the size of the obstructed area caused by valve-manner motion of these lesions. 3,7,8 According to Desle´e et al, 8 delay from extubation to first symptoms varied between 14 hours and 9 days, with an average of about 29 hours.…”

“…3,5,7,8 Postintubation mucosal lesions that develop in the form of a cord either remain asymptomatic until diagnosed accidentally during an unexpectedly difficult intubation or cause symptoms that are hardly distinguishable from an asthmatic episode. [3][4][5][6] Kokkonouzis et al 5 proposed an explanation for the development of these postintubation tracheal webs/cords. According to them, the outer walls of the endotracheal tubes might serve as a matrix on which inflammatory cells from the neighboring injured tracheal wall eventually form a web/cord-like fibrotic tissue in a few months.…”

Shortness of breath caused by a tracheal web

“…2 Patients are often misdiagnosed as having refractory asthma or chronic obstructive lung disease due to the wheezing and the recurrent chest infections. These patients can also be asymptomatic and diagnosed accidentally after difficult endotracheal intubations for surgical procedures.…”

“…Congenital tracheal webs are rare with an incidence of 1 in 10,000 births; they are usually undiagnosed in infancy and often misdiagnosed later. 2 A tracheal web is formed by a thin layer of membranous tissue containing small holes that cause the tracheal lumen to narrow leading to partial airway obstruction. Affected patients usually complain of wheezing, dyspnea, stridor, recurrent respiratory infections, and sometimes respiratory failure.…”