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Tang W, Zhou W, Zheng X. Obstructive Fibrinous Tracheal Pseudomembrane Following Repeated Intratracheal Interventions. Drug Healthc Patient Saf 2024; 16:29-33. [PMID: 38476932 PMCID: PMC10927874 DOI: 10.2147/dhps.s438510] [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: 09/23/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a relatively rare complication of endotracheal intubation. Despite being well documented, the exact pathogenesis of OFTP remains unclear. Some studies suggest that it may arise from the early stage of ischemic tracheal wall injury caused by the cuff pressure during intubation. Diagnosis and treatment of OFTP can be facilitated through therapeutic bronchoscopy. In this case report, we describe a patient who presented with dyspnea following repeated intratracheal interventions and was diagnosed with OFTP. The patient was successfully treated with bronchoscopic cryotherapy and was subsequently discharged from the hospital.
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Affiliation(s)
- Wei Tang
- Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, People’s Republic of China
| | - Wenlai Zhou
- Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, People’s Republic of China
| | - Xiangde Zheng
- Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, People’s Republic of China
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Chua JH, Sim BLH, Theng TKP, Chew S. Obstructive fibrinous pseudomembrane tracheitis after double lumen tube intubation: a case report. Korean J Anesthesiol 2022; 75:350-353. [PMID: 35189677 PMCID: PMC9346278 DOI: 10.4097/kja.21460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Obstructive fibrinous pseudomembrane tracheitis (OFPT) is a rare complication of endotracheal intubation. Case We describe the case of a 73-year-old woman who underwent short-term intubation for video-assisted thoracoscopic surgery and developed an acute life-threatening stridor two days after extubation. The patient required an emergency tracheostomy to maintain airway patency and a microscopic direct laryngoscopy procedure was performed thereafter with removal of the obstructive pseudomembrane. Subsequently, the patient also suffered a non-ST-elevation myocardial infarction. The patient successfully recovered, and the tracheostomy was subsequently decannulated two months later. Histological examination revealed mucosal ulcerations and inflammatory changes. Conclusions OFPT is an uncommon cause of life-threatening airway obstruction after extubation that is not often recognized immediately but can usually be treated with early bronchoscopic intervention or microscopic direct laryngoscopy.
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Nivy R, Brenner O, Shub V, Bruchim Y. Obstructive fibrinous tracheal pseudomembrane in a cat. J Vet Intern Med 2020; 34:2687-2690. [PMID: 33098319 PMCID: PMC7694847 DOI: 10.1111/jvim.15944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 12/03/2022] Open
Abstract
Tracheal intubation (TI) is a common procedure that rarely entails life‐threatening complications. A 1.5‐year‐old female spayed cat presented with acute signs of respiratory distress 5 weeks after undergoing TI. Radiographs revealed a marked, segmental, tracheal narrowing. A hard, 5‐cm‐long, white‐yellowish tissue was identified and removed from the trachea, with subsequent resolution of clinical signs and radiographic changes. Microscopically, the tissue consisted of fibrin and lytic neutrophils, interspaced with optically empty cavities and a few remains of talcum powder and hair shafts. Consequently, a diagnosis of obstructive fibrinous tracheal pseudomembrane (OFTP) was made. A rare complication of TI in humans, OFTP should also be suspected in cats with respiratory distress, a history of TI and radiographic evidence of tracheal narrowing. Based on cases from other species and the cat described herein, the condition can be easily resolved with OFTP removal.
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Affiliation(s)
- Ran Nivy
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel.,Department of Internal Medicine, Ben-Shemen Specialist Referral Center, Ben-Shemen, Israel
| | - Ori Brenner
- Department of Veterinary Resources, Weizmann Institute, Rehovot, Israel
| | - Vered Shub
- Department of Internal Medicine, Ben-Shemen Specialist Referral Center, Ben-Shemen, Israel
| | - Yaron Bruchim
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel.,Department of Internal Medicine, Ben-Shemen Specialist Referral Center, Ben-Shemen, Israel
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Sahu SR, Madan K, Mohan A, Mittal S. Obstructive fibrinous tracheal pseudomembrane following tracheal stent placement: An underrecognized entity. Lung India 2020; 37:453-454. [PMID: 32883911 PMCID: PMC7857365 DOI: 10.4103/lungindia.lungindia_1_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satya Ranjan Sahu
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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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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