Obstructive fibrinous tracheal pseudo-membrane post-intubation; A rare yet critical complication

Abstract

This case report discusses Obstructive Fibrinous Tracheal Pseudomembrane (OFTP) in a 33-year-old female patient, who underwent caesarean section complicated by eclampsia, and required mechanical ventilation (MV) for two days. Two days post-extubation, she developed gradually progressive exertional dyspnoea, noisy breathing (stridor), and respiratory distress with oxygen desaturation on mild exertion. Computerised tomography scan of the neck and flexible fibre-optic bronchoscopy revealed an 80% tracheal narrowing due to a thick tubular mucoid membrane, 5 cm along its length, 2 cm below the vocal cords, and 3 cm above the carina. The membrane, a thick yet pliable whitish-yellow structure, exhibited dynamic movement synchronised with the patient's breathing. Urgent rigid bronchoscopy was performed to remove the obstructive pseudomembrane which successfully restored tracheal patency. Histological examination confirmed the presence of necro-inflammatory fibrinous debris suggestive of endotracheal tube-related trauma. This case highlights the importance of prompt recognition and intervention in OFTP, a potentially life-threatening complication of endotracheal intubation. The patient recovered completely with no residual airway obstruction or symptoms at discharge.

Keywords: Endotracheal intubation; Obstructive fibrinous tracheal pseudomembrane; OFTP; Respiratory distress; Rigid bronchoscopy; Stridor.