Stridor due to a bridge-like subglottic stenosis in a 10-week-old male infant

Dinther, Joost J. S. van; Boudewyns, An; Jorens, P. G.; Claes, J.; Heyning, Paul Van de

doi:10.1016/j.ijporl.2008.09.029

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…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.…”

Section: Discussionmentioning

confidence: 85%

“…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]12,13,17,18,22 Further, OFTP has also been reported in subjects where the cuff pressure was maintained below 25 cm H 2 O 6,19,22 and in subjects who were intubated for as little as half an hour. 6,13 Aspiration of gastric contents leading to caustic injury has also been proposed as a contributing factor.…”

Section: Discussionmentioning

confidence: 99%

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Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

Sehgal¹,

Dhooria²,

Bal

et al. 2016

Respir Care

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Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the PubMed and EmBase databases for all the cases describing OFTP. The systematic search yielded 28 citations describing 53 subjects with OFTP. The study population (61.1% females) comprised of both adults and pediatric subjects with a median (IQR) age of 40.5 (14.8 -60.5) years. The median (IQR) size of endotracheal tube was 7.5 (6 -9.3) mm with a median (IQR) duration of intubation of 36 (14 -96) hours. The median (IQR) time to onset of symptoms after extubation was 24 (6 -96) hours. Stridor was the most common symptom. The average delay in correctly identifying the OFTP was 26 hours. The diagnosis of tracheal pseudomembrane was confirmed by flexible bronchoscopy in 38 (70.4%) instances while rigid bronchoscopy was used in 46.3% subjects for removing the pseudomembrane. There were two deaths, one each in an adult and a pediatric subject. OFTP is a complication of tracheal intubation and presents with respiratory failure. The diagnosis can be confirmed by flexible bronchoscopy. Treatment involves removal of the obstructing membrane with either flexible or rigid bronchoscopy.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation

Sehgal¹,

Dhooria²,

Bal

et al. 2016

Respir Care

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“…In seven infants, laryngomalacia was associated with a second airway lesion. In one infant, laryngomalacia was secondary to an intubation injury presenting as a subglottic pseudomembranous bridge and resolved after surgical removal of this subglottic bridge [27]. These figures support the recommendation of Bluestone advocating a rigid endoscopy in patients with laryngomalacia to exclude secondary airway lesions [15].…”

Section: Chronic Stridormentioning

confidence: 66%

Clinical practice

2009

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Stridor is the sound caused by abnormal air passage during breathing. The cause of stridor can be located anywhere in extrathoracic airway (nose, pharynx, larynx, and trachea) or the intrathoracic airway (tracheobronchial tree). Stridor may be acute (caused by inflammation/infection or foreign body inhalation) or chronic. It may be congenital or acquired. Stridor is a sign from which the underlying cause must be sought; it is not a diagnosis. The role of the pediatrician faced with a child or infant with noisy breathing is: (1) to determine the severity or respiratory compromise and the need for immediate intervention (to prevent respiratory failure); (2) to decide based upon history and clinical examination whether a significant lesion is suspected and, in the latter situation, to refer the child to an ENT surgeon for an upper and lower airway endoscopy; (3) to understand the consequences and management strategies of the underlying lesion and to collaborate with colleagues from related disciplines for follow-up and subsequent management of the child.

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“…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.…”

Section: Discussionmentioning

confidence: 99%