A Rare Mechanical Cause of Extubation Failure After Short-Term Intubation and Outgoing with the Stridor Clinic: Obstructive Fibrinous Tracheal Pseudomembrane : A CASE REPORT

Abstract

Stridor after extubation is generally a clinical symptom that may indicate laryngeal edema or vocal cord injury due to intubation, and hoarseness may accompany this.The presence of stridor may cause reintubation due to upper airway obstruction, a risk factor for patient mortality and morbidity.Laryngeal edema and vocal cord damage are mostly seen as the cause of stridor.In this case, OFTP (Obstructive fibrinous tracheal pseudomembrane) and stridor in the lower line of the vocal cords, which are rarely seen during short-term intubation, are presented.

Keywords

• obstructive fibrinous tracheal membrane
• post extubation stridor
• fiberoptic bronchoscopy
• medical intensive care unit

References

1. 1.Frutos-Vivar, F., Esteban, A., Apezteguia, C., González, M., Arabi, Y., Restrepo, M. I., Gordo, F., Santos, C., Alhashemi, J. A., Pérez, F., Peñuelas, O., & Anzueto, A. (2011).Outcome of reintubated patients after scheduled extubation. Journal of critical care, 26(5), 502–509. https://doi.org/10.1016/j.jcrc.2010.12.015
2. 2.Miltiades, A. N., Gershengorn, H. B., Hua, M., Kramer, A. A., Li, G., & Wunsch, H. (2017). Cumulative probability and time to reintubation in U.S. ICUs. Critical care medicine, 45(5), 835-842. https://doi.org/10.1097/CCM.0000000000002327
3. 3.Pluijms, W.A., van Mook, W.N., Wittekamp, B.H. et al. Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review. Crit Care 19, 295 (2015). https://doi.org/10.1186/s13054-015-1018-2
4. 4.Zochios, V., Protopapas, A. D., & Valchanov, K. (2015). Stridor in adult patients presenting from the community: An alarming clinical sign. Journal of the Intensive Care Society, 16(3), 272–273. https://doi.org/10.1177/1751143714568773
5. 5.Lilienstein JT, Davis JW, Bilello JF, Dirks RC. risk factors associated with post -extubation stridor in the trauma intensive resort unit The American Journal of Surgery.2016;212:379 -83. https://doi.org/10.1016/j.amjsurg.2016.02.010.
6. 6.Vallés, J., Millán, S., Díaz, E., Castanyer, E., Gallardo, X., Martín-Loeches, I., Andreu, M.,Prenafeta, M., Saludes, P., Lema, J., Batlle, M., Bacelar, N., & Artigas, A. (2017). Incidence of airway complications in patients using endotracheal tubes with continuous aspiration of subglottic secretions. Annals of intensive care, 7(1), 109. https://doi.org/10.1186/s13613-017- 0331-0
7. 7.El-Baradey, G. F., El-Shmaa, N. S., & Elsharawy, F. (2016). Ultrasound-guided laryngeal air column width difference and the cuff leak volume in predicting the effectiveness of steroid therapy on postextubation stridor in adult. Are they useful?. Journal of critical care, 36, 272– 276. https://doi.org/10.1016/j.jcrc.2016.07.007
8. 8.Jaber, S., Chanques, G., Matecki, S., Ramonatxo, M., Vergne, C., Souche, B., Perrigault, P. F., & Eledjam, J. J. (2003). Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive care medicine, 29(1), 69–74. https://doi.org/10.1007/s00134-002-1563-4

9. 9.Cheng, K. C., Chen, C. M., Tan, C. K., Chen, H. M., Lu, C. L., & Zhang, H. (2011).Methylprednisolone reduces the rates of postextubation stridor and reintubation associated with attenuated cytokine responses in critically ill patients. Minerva anestesiologica, 77(5),503–509. PMID: 21540805; PMCID: PMC3929386. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929386/
10. 10.Sigrist T, Dirnhofer R, Patscheider H. [Rare complications following tracheotomy and intubation (author's transl)] Anaesthesist. 1981 Oct;30(10) 523-527. PMID: 7304907. https://pubmed.ncbi.nlm.nih.gov/7304907/
11. 11.Sehgal, I. S., Dhooria, S., Bal, A., Aggarwal, A. N., Behera, D., & Agarwal, R. (2016). Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation. Respiratory care, 61(9), 1260–1266. https://doi.org/10.4187/respcare.04662
12. 12.Lins, M., Dobbeleir, I., Germonpré, P., Waelput, W., Pauwels, P., & Jorens, P. G. (2011). Postextubation obstructive pseudomembranes: a case series and review of a rare complication after endotracheal intubation. Lung, 189(1), 81–86. https://doi.org/10.1007/s00408-010-92632
13. 13.Ammar, Y., Vella-Boucaud, J., Launois, C., Vallerand, H., Dury, S., Lebargy, F., Deslee,G., & Perotin, J. M. (2017). Obstructive Fibrinous Tracheal Pseudomembrane. Anesthesia and analgesia, 125(1), 172–175. https://doi.org/10.1213/ANE.0000000000001408
14. 14.Kang, H. H., Kim, J. W., Kang, J. Y., Kim, J. S., Kim, M. S., Kim, S. S., Kim, Y. H., Lee, S. H., & Moon, H. S. (2010). Obstructive fibrinous tracheal pseudomembrane after tracheal intubation: a case report. Journal of Korean medical science, 25(9), 1384–1386. https://doi.org/10.3346/jkms.2010.25.9.1384