Obstructive Fibrinous Tracheal Pseudomembrane: An Update

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Acute Crit Care. 2014;29(3):241-242

Publication date (electronic) : 2014 August 31

doi : https://doi.org/10.4266/kjccm.2014.29.3.241

Alberto Manassero, M.D., Matteo Bossolasco, M.D.

Department of Anesthesiology and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy

Correspondence to: Alberto Manassero, Department of Anesthesiology and Critical Care, S. Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy. Tel: +39-0171-642025, Fax: +39-0171-642010, E-mail: manassero.al@ospedale.cuneo.it

Received 2014 July 28; Accepted 2014 August 19.

Dear Editor,

We read with interest the excellent report of Ha et al.,[1] because we faced another case[2] of this poorly understood pathology.

Obstructive fibrinous tracheal pseudo-membrane (OFTP) is a rare, but potentially lethal pathology which develops after endotracheal intubation even of short duration (24 hours in our case). As outlined by Ha, most of reported cases had a clinical presentation characterized by dyspnea and stridor, due to a valve-like tracheal obstruction by a partial detachment of the pseudo-membrane, which occurred early after extubation. In the case reported by Ha et al.[1], the patient complained a mild dyspnea probably related to the ongoing development of the right lower lobe atelectasis, but certainly unrelated to the presence in the upper trachea of the pseudo-membrane. As a consequence, the authors speculated that the OFTP presence was asymptomatic and its diagnosis has been fortuitous, condition only two-time described before.[3] We would like to point out that the diagnosis of OFTP in our case was even more fortuitous, because of its spontaneous expectoration after cough triggered by an attempt of nasogastric tube insertion; the diagnosis occurred after a long asymptomatic time post-extubation (four days). Spontaneous expectoration has been reported only once before[4] and, as far as we know, it is the only way to obtain a detach of the OFTP in its integrity like a trachea’s mold (Fig. 1). We agree with Ha about the difficulty in finding clear risk factors of OFTP formation since the rarity of reported cases. Hyperinflation of endotracheal cuff, so far thought to be the major risk factor, in the case by Ha et al.[1] was absent (endotracheal cuff pressure was checked routinely and adjusted) as well as others known risk factors. We can ironically conclude that endotracheal intubation is the only known risk factor for OFTP development.

Fig. 1.

Picture shows the obstructive fibrinous tracheal pseudo-membrane in its integrity.

Notes

No potential conflict of interest relevant to this article was reported.

References

1). Ha JH, Lee H, Park YJ, Kang HH, Moon HS, Lee SH. Obstructive fibrinous tracheal pseudomembrane presented with atelectasis. Korean J Crit Care Med 2014;29:110–3.

2). Manassero A, Ugues S, Bertolaccini L, Bossolasco M, Terzi A, Coletta G. A very early stage of obstructive tracheal pseudo-membrane formation. J Thorac Dis 2012;4:320–2.

3). Deslée G, Brichet A, Lebuffe G, Copin MC, Ramon P, Marquette CH. Obstructive fibrinous tracheal pseudomembrane. A potentially fatal complication of tracheal intubation. Am J Respir Crit Care Med 2000;162(3 Pt 1):1169–71.

4). Fiorelli A, Vicidomini G, Messina G, Santini M. Spontaneous expectoration of an obstructive fibrinous tracheal pseudomembrane after tracheal intubation. Eur J Cardiothorac Surg 2011;40:261–3.

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Fig. 1.

Picture shows the obstructive fibrinous tracheal pseudo-membrane in its integrity.