Postextubation obstructive pseudomembranes: a case series and review of a rare complication after endotracheal intubation

Abstract

Endotracheal intubation obviously may be life-saving, but it may also lead to complications, including those related to damage of the airways. Superficial damage of the trachea at the site of the endotracheal cuff may trigger the formation of an obstructive fibrinous tracheal pseudomembrane (OFTP). Shortly after extubation, this clot, consisting of fibrin, leucocytes, and necrotic epithelium, can cause stridor due to adherence to the tracheal wall and obstruction of the airway. In most cases, the lesion is easily removed by rigid or fiberoptic bronchoscopy and virtually never leads to permanent damage. The study consisted of case series and review of the literature. This report describes a series of five adult cases and reviews all 19 other previously described cases. A careful analysis of all reported cases, however, did not highlight a simple predisposing factor or illness. It is important to consider OFTP in the differential diagnosis of stridor and respiratory insufficiency in the postextubation period.