Akademik Veri Yönetim Sistemi
5th International Hippocrates Congress on Medical and Health Sciences, Ankara, Türkiye, 18 - 19 Aralık 2020, ss.417-418
Introduction
Children with life-threatening conditions are followed in pediatric intensive care units (PICU). Some of them need endotracheal intubation and invasive mechanical ventilation support. Endotracheal intubation is a procedure performed for a lot of indications.1,2 Obstructive fibrinous tracheal pseudomembrane (OFTP) is a very rare life-threatening complication that results after endotracheal intubation and leads to failure of weaning from mechanical ventilation.3 Here, we present an illustrative case on OFTP that complicates endotracheal intubation in our PICU.
Case
A 9-year-old boy who developed posterior reversible encephalopathy after post-streptococcal glomerulonephritis was intubated and mechanically ventilated for 3 days in PICU. In the patient who was extubated were seen upper airway obstruction signs such as stridor, cough and severe dyspnea. He was treated with inhaled epinephrine, hypertonic saline, corticosteroids and systemic corticosteroids. The next day, he was reintubated because of increased respiratory distress symptoms and decreased arterial oxygen pressure. The patient was extubated 24 hours after the second intubation, and respiratory distress findings developed again within hours. Computed tomography scans showed pneumomediastinum, subcutaneous emphysema secondary to OFTP (Fig 1; A, B). The patient was consulted thoracic surgery clinic. Bronchoscopy was performed and the pseudomembrane was removed (Fig 1; C, D). After bronchoscopy clinical complaints has disappeared. Fig 1: A, B: Computed tomography scans showed pneumomediastinum, subcutaneous emphysema; C, D: Bronchoscopy was performed and the pseudomembrane was removed
Conclusion
OFTP was first reported by Sigrist et al in 1981.4 In the etiology of the tracheal pseudomembrane superficial mucosal abrasion and desquamation of necrotic tracheal epithelium are accused.5,6 In case of severe dyspnea and stridor after extubation should be suspected this life-threatening condition, and computed tomography and bronchoscopy should be performed for diagnosis.
Key Words: pediatric intensive care unit, tracheal pseudomembrane, bronchoscopy