Obstructive fibrinous tracheal pseudomembrane after tracheal intubation

Abstract

Obstructive fibrinous tracheal pseudomembrane is a rare complication that can develop after endotracheal intubation. It usually presents as a sudden airway obstruction and culminates in failed extubation.

We describe a clinical case of a patient with septic shock secondary to severe community pneumonia who required endotracheal intubation and mechanical ventilation and who presented two extubation failures due to inspiratory stridor; reason why a tracheostomy was performed. Subsequently, the airway was evaluated through flexible bronchoscopy where a pseudomembrane was observed, which exerted a valve mechanism that obstructed the distal end of the tracheostomy cannula almost completely, so it was decided to extract the cannula and secure the airway by endotracheal intubation.

After 48 hours, the bronchoscopic study was repeated, which did not show residual pseudomembranes.

It is considered that the timely diagnosis of the tracheal pseudomembrane through endoscopic exploration of the airway was decisive for the patient to be successfully extubated.