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Abstract
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare and potentially severe complication of endotracheal intubation characterized by a tubular pseudomembrane that obstructs the trachea and induces clinical symptoms of airway obstruction after extubation. In this report, we reviewed and summarized all published cases of OFTP (n = 58) between 1981 and 2015. Twenty-three of 52 patients were men, and the mean age was 36 ± 22 years. Intubation was emergent in 41 of 53 cases. OFTP was revealed by acute symptoms in 19 of 39 cases and led to acute respiratory failure in 13 of 39 cases. Symptoms occurred 3 ± 3 days after extubation. A tracheal obstruction ≥70% was observed in 14 of 18 cases. Bronchoscopic removal was performed in 49 of 58 cases with no recurrence. In conclusion, OFTP is characterized by a typical clinical and endoscopic presentation, with no recurrence after bronchoscopic removal. Early recognition and bronchoscopy are key elements for efficient diagnosis and treatment.
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Nakamura M, Hisamura M, Hashimoto M, Sawano M, Joshita M, Toi T, Asano Y, Matsueda H, Arima F, Oi H, Kitawaki T, Ando Y, Koshimizu K. Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway. Respir Med Case Rep 2017; 21:36-38. [PMID: 28377879 PMCID: PMC5369857 DOI: 10.1016/j.rmcr.2017.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 12/01/2022] Open
Abstract
We report a rare case of acquired membranous tracheal stenosis in a patient with anorexia nervosa and a history of self-induced vomiting, but without a history of tracheal intubation or tracheostomy. A 50-year-old woman presented with difficulty in breathing and swallowing, self-expectoration, and impaired consciousness due to acute benzodiazepine intoxication. Bronchoscopic examination was performed after tracheotomy and placement of a tracheostomy tube failed to secure her respiratory tract and ventilation continued to deteriorate. A flap-like membranous structure was identified on the posterior tracheal wall, obstructing the tracheostomy tube. Physical compression of the membranous structure improved ventilation. Bronchoscopic examination is generally recommended prior to performing tracheostomy in patients suspected to have post-intubation tracheal obstruction. Based on our findings, we suggest that these examinations should also be performed in patients with conditions associated with chronic irritation of the respiratory tract, including those with a prolonged history of self-induced vomiting.
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Affiliation(s)
- Motohiro Nakamura
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Masaki Hisamura
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Masayuki Hashimoto
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Makoto Sawano
- Department of Emergency Medicine and Critical Care, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Midori Joshita
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Takahiro Toi
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Yoshitaka Asano
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Hideyo Matsueda
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Fumihito Arima
- Department of Emergency Medicine and Critical Care, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Hidenori Oi
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Takehiro Kitawaki
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Yoji Ando
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
| | - Kenji Koshimizu
- Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan
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Manassero A, Ugues S, Bertolaccini L, Bossolasco M, Terzi A, Coletta G. A very early stage of obstructive fibrinous tracheal pseudo-membrane formation. J Thorac Dis 2012; 4:320-2. [PMID: 22754673 DOI: 10.3978/j.issn.2072-1439.2012.05.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/17/2012] [Indexed: 11/14/2022]
Abstract
As result of a short-term intubation (24 hours), we report a rare and poorly known complication: the formation of an obstructive fibrinous tracheal pseudo-membrane (OFTP). The diagnosis and therapy of OFTP were due to its spontaneous expectoration after a long asymptomatic time post extubation (four days): This is a very unusual event. A CT-scan of the chest performed 3 hours after intubation revealed the first step of pseudo-membrane developing.
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Ledl C, Mertl-Roetzer M. Tracheal and Tracheostomal Hypergranulation and Related Stenosis in Long-Term Cannulated Patients: Does the Tracheostomy Procedure Make a Difference? Ann Otol Rhinol Laryngol 2009; 118:876-80. [DOI: 10.1177/000348940911801208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Long-term cannulated patients are at risk of developing tracheal and tracheostomal hypergranulation. This study evaluated the incidence of hypergranulation and related tracheal stenosis in long-term cannulated patients. The relation between hypergranulation, specific tracheostomy techniques, and the duration of cannulation was investigated. Methods: A prospective observational study was conducted to analyze tracheostomal and tracheal hypergranulation in long-term cannulated patients. We compared complication rates in 344 postacute patients. Tracheas and tracheostomas were inspected visually and endoscopically at admission and at regular tube changes every 2 weeks until decannulation or discharge. Results: Hypergranulation appeared 3 times as often in the tracheostoma (n = 338) as in the trachea (n = 109). There was no influence of the tracheostomy procedure on the frequency (p = 0.931), location (tracheostoma, p = 0.947; trachea, p = 0.918), or severity (stenoses grade I, p = 0.910; grade II, p = 0.649; grade III, p = 0.304) of the hypergranulation. The main factors to account for hypergranulation were the duration of cannulation (p < 0.001) and age (p = 0.033). Conclusions: There was no influence of tracheostomy techniques on hypergranulation. Its development depends on the duration of cannulation. It is recommended to keep the duration of cannulation as short as possible with respect to the underlying neurologic impairment.
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Tracheal web: presentation of a case with uncommon features. J Bronchology Interv Pulmonol 2009; 16:46-8. [PMID: 23168469 DOI: 10.1097/lbr.0b013e3181908c5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Postintubation tracheal web is a rarely encountered complication of endotracheal intubation. Although few of them remain asymptomatic until diagnosed accidentally, most of them present with symptoms of acute airway obstruction and even death. We present here a case of postintubation tracheal web with uncommon features, including a very long delay in diagnosis despite a 99% obstruction of the tracheal lumen.
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Walter S, Gasthaus M, Schatz J, Koop I, Paschen HR. Akute subglottische Trachealstenose nach Reanimation. Anaesthesist 2007; 56:790-2. [PMID: 17541522 DOI: 10.1007/s00101-007-1195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Following cardiac arrest a 41-year-old patient was resuscitated for 40 min and required mechanical ventilation for 27.5 h. Acute shortness of breath and inspiratory stridor developed 7 days after successful extubation. Bronchoscopy revealed a subtotal tracheal stenosis caused by extensive fibrinous membranes. Local ischaemia caused by cuff pressure seems to be a likely explanation with an additional component of general hypoperfusion and haemodynamic instability which led to gastric bleeding (classification according to Forrest IIc) from ischaemic ulcers.
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Affiliation(s)
- S Walter
- Abteilung für Anästhesiologie und Intensivmedizin, Evangelisches Amalie Sieveking-Krankenhaus, Akad. Lehrkrankenhaus der Universität Hamburg, Haselkamp 33, 22359 Hamburg.
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