Pediatric Post Intubation Obstructive Fibrinous Tracheal Pseudomembrane

Objectives: Report a rare case of obstructive fibrinous tracheal pseudomembrane (OFTP) in a pediatric patient and to present a literature review on OFTP. Methods: A PubMed search was conducted which revealed a total of 21 individual case reports and 6 case series of OFTP. Relevant data was collected from these publications and analyzed. Results: 55 patients with OFTP were identified. Age ranged from 6wk to 85yr, with mean age (± SD) of 34.34 yr (±25.6). 33 were female and 22 were male. The reason for initial intubation varied, and included trauma (n=5), altered sensorium (n=9), respiratory failure (n=15), and intubation for surgical procedure (n=21). The duration of intubation ranged from 30 minutes to 17 days, with mean duration (±SD) of 76.24 hours (±103.72). The duration from extubation until onset of symptoms was almost immediate to 2 weeks, with mean duration (±SD) of 52.30 hours (±73.51). No clear risk factor for development of OFTP was identified. Majority of patients, 45/55 (82%), were treated with bronchoscopy. Most patients, 49/55 (89%), recovered, without any sequelae, but there were few deaths, 3/55 (5%). Conclusion: OFTP is a rare, but serious and potentially life threatening cause of post extubation respiratory distress. No risk factor could be identified which may predispose to development of OFTP. Bronchoscopy confirms the diagnosis and removal of the fibrinous exudate is associated with a high rate of recovery without sequelae.