Obstructive fibrinous tracheal pseudomembrane - A potentially fatal complication of tracheal intubation

A series of 10 consecutive cases presenting an obstructive fibrinous trache al pseudomembrane (OFTP) as a complication of endotracheal intubation is pr esented. The patients developed a thick tubular, rubber-like, whitish pseud omembrane moulding the tracheal wall as a result of short-duration endotrac heal intubation. This pseudomembrane firmly adhered to the tracheal wall at the site of the endotracheal cuff, Shortly after extubation, partial detac hment of the proximal part of the pseudomembrane produced intermittent posi tional acute respiratory failure due to valve-manner tracheal obstruction. Immediate mechanical ablation was curative in nine patients, without second ary development of tracheal stenosis. One patient died from acute asphyxiat ion. The history and the pathological findings of these cases support the h ypothesis that this lesion represents an early stage of ischemic tracheal w all injury related to the cuff pressure. Pulmonary physicians should be ale rted on this poorly known complication of endotracheal intubation.