Successful Management of Obstructive Fibrinous Tracheal Pseudomembrane with a Coring Technique after Preoxygenation with a High-Flow Nasal Cannula: A Case Report.

INTRODUCTION

Obstructive fibrinous tracheal pseudomembrane, an extremely rare but potentially fatal complication of tracheal intubation, occurs several days after intubation and is characterized by central airway obstruction due to the formation of a fibrinous pseudomembrane. Early diagnosis is crucial. Treatment typically involves bronchoscopic removal of the pseudomembrane. Herein, we describe a patient whose pseudomembrane was successfully cored out using fiberoptic intubation after achieving preoxygenation with high-flow nasal cannula oxygen therapy.

CASE PRESENTATION: An 83-year-old woman (height 146 cm, weight 38 kg) underwent left lower lobe lobectomy with left atrial resection for squamous cell carcinoma (cT4N1M0, Stage IIIA). The surgery was completed successfully with no immediate complications. On POD 3, she developed prolonged expiration and inspiratory wheezing that was unresponsive to steroid inhalation. Her condition progressively worsened with stridor, labored breathing, and inability to lie supine. Bronchoscopy revealed 90% circumferential subglottic stenosis. High-flow nasal cannula oxygen therapy significantly improved her respiratory distress, enabling her to lie supine. Fiberoptic intubation was then performed under conscious sedation with spontaneous breathing, and the circumferential membranous structure was cored out by the intubation tube. Pathological examination confirmed fibrinous exudate with atypical cells, establishing a diagnosis of obstructive fibrinous tracheal pseudomembrane.

CONCLUSIONS

Obstructive fibrinous tracheal pseudomembrane, a rare condition, causes upper airway obstruction within days after extubation. Preoxygenation with high-flow nasal cannula oxygen therapy, followed by coring the pseudomembrane out with an intubation tube, may be an effective, rapid, and minimally invasive means of treatment in selected patients with a subglottic, obstructive, fibrinous tracheal pseudomembrane.