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Am. J. Respir. Crit. Care Med., Volume 162, Number 3, September 2000, 1169-1171

Obstructive Fibrinous Tracheal Pseudomembrane
A Potentially Fatal Complication of Tracheal Intubation

GAETAN DESLÉE, ANNE BRICHET, GILLES LEBUFFE, MARIE CHRISTINE COPIN, PHILIPPE RAMON, and CHARLES HUGO MARQUETTE

Clinique des Maladies Respiratoires, Hôpital A. Calmette, Département d'Anesthésie II, Hôpital Claude Huriez, and Service d'Anatomopathologie, Hôpital A. Calmette, CHRU de Lille, France

A series of 10 consecutive cases presenting an obstructive fibrinous tracheal pseudomembrane (OFTP) as a complication of endo-tracheal intubation is presented. The patients developed a thick tubular, rubber-like, whitish pseudomembrane moulding the tracheal wall as a result of short-duration endotracheal intubation. This pseudomembrane firmly adhered to the tracheal wall at the site of the endotracheal cuff. Shortly after extubation, partial detachment of the proximal part of the pseudomembrane produced intermittent positional acute respiratory failure due to valve-manner tracheal obstruction. Immediate mechanical ablation was curative in nine patients, without secondary development of tracheal stenosis. One patient died from acute asphyxiation. The history and the pathological findings of these cases support the hypothesis that this lesion represents an early stage of ischemic tracheal wall injury related to the cuff pressure. Pulmonary physicians should be alerted on this poorly known complication of endotracheal intubation.




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