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Obstructive Fibrinous Tracheal Pseudomembrane Following Short-Term Intubation: A Case Report and Management
Sami Khoury1, Kevin Fung1, Peng You1
1Department of Otolaryngology-Head and Neck Surgery Schulich School of Medicine & Dentistry Western University London Ontario Canada uwo.ca.
Introduction:
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare but serious complication of endotracheal intubation that can cause airway obstruction, postextubation stridor, and respiratory distress. Due to its nonspecific presentation, it is often misdiagnosed and early recognition and intervention are critical to prevent respiratory compromise.
Case:
We present the case of a 17-year-old female who required 36 h of intubation for status epilepticus. She developed stridor within 24 h of extubation and presented with subglottic narrowing that did not respond to medical treatment. Bronchoscopy revealed a fibrinous pseudomembrane coating the subglottic and tracheal mucosa down to the carina, which was successfully removed, leading to complete symptom resolution. She did not have any recurrence postoperatively and no residual symptoms at her follow-up.
Discussion:
This case highlights the importance of considering OFTP in patients with postextubation stridor refractory to medical therapy. While ischemic injury from high endotracheal cuff pressures is a known cause, mechanical trauma and aspiration may also contribute. Bronchoscopy is essential in the diagnosis and treatment of this condition.