Very rare. Formation of a thick pseudomembrane, consisting of fibrinous sterile material containing polymorphonuclear neutrophils from the tracheal mucosa, that gets symptomatic after extubation. Healing without sequelae after a bronchoscopy to remove membranes.

Clinical features:

-        variable duration of intubation from 30 minutes to several days

-        variable time to onset of clinical signs: from 1 hour to several days after extubation

-        signs: stridor, dyspnea, acute respiratory failure, respiratory arrest, expectoration of a tracheal mold, sometimes diagnosis at autopsy

-        diagnosis: bronchoscopy: tracheal obstruction by a tubular pseudomembrane, usually at the level of the upper 1/3 of the trachea

Triggering factors: intubation with a overinflated cuffed endotracheal tube, traumatic intubation, emergency intubation, caustic or inhalational burn of the trachea, bronchial inhalation

Anesthetic implications: 

diagnosis to be kept in mind in presence of signs and symptoms of upper airway obstruction after intubation, not responding to administration of adrenaline or corticosteroids. Differential diagnosis: subglottic or tracheal stenosis, foreign body or edema. Management of a bronchoscopy (flexible or rigid) in a patient in respiratory distress  and/or hypoxemic.

References : 

-        Birch CW, Salkeld LJ.
A rare tracheal lesion.
Pediatr Anesth 2005; 15:73-6.

-        Berger TM, Jöhr M.
Subglottic fibrinous cast.
Pediatr Anesth 2005; 15:622-3.

-        van Dinther JJS, Boudewyns AN, Jorens PhG, Van Marck V, Claes J, Van de Heyning PH.
Stridor due to a bridge-like subglottic stenosis in a 10-week-old male.
Int J Pediatr Otorhinolaryngol 2009; 73: 159-62

-        Vanderheyde K, Pieters T, Rodenstein D.
A 19-year-old man with dyspnea and stridor after surgery.
Respiration 2011; 81: 63-6.

-        Ammar Y, Vella-Boucaud J, Launois C, Vallerand H, Dury S et al.
Obstructive fibrinous tracheal pseudomembrane.
Anesth Analg 2017 ; 125 : 172-5.

Updated: August 2017