Obstructive Fibrinous Tracheal Pseudomembrane Research Articles

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

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.

Acute respiratory failure from an obstructive fibrinous tracheal pseudomembrane.

Acute respiratory failure from an obstructive fibrinous tracheal pseudomembrane.

20 - Coughing up a lung? Expectoration of obstructive fibrinous tracheal pseudomembrane

20 - Coughing up a lung? Expectoration of obstructive fibrinous tracheal pseudomembrane

AIRWAY OBSTRUCTION FROM INFECTION-RELATED TRACHEOBRONCHIAL PSEUDOMEMBRANES

SESSION TITLE: Infectious Complications with Obstructions and ConnectionsSESSION TYPE: Case ReportsPRESENTED ON: 10/17/2022 03:15 pm - 04:15 pmINTRODUCTION: Tracheobronchial pseudomembranes are thick, tissue-like films comprised of endobronchial mucous production and sloughing of necrotic mucosal epithelium in response to infection, trauma, or aspiration (2). Of the infectious etiologies aspergillus is most cited in the literature (3). A feared complication of pseudomembrane development is airway obstruction, which is described in this case.CASE PRESENTATION: A 58-year-old male with a history of relapsed diffuse large B cell lymphoma presented with neutropenic fevers and bilateral consolidations on chest CT. He was started on broad spectrum antibiotics, but his respiratory status declined requiring intubation. Bronchoscopy showed diffuse pseudomembranes with partial obstruction of the major airways that were removed with cryotherapy. Pathology showed pseudomembrane formation with membrane-like fibrin fragments and multiple gram-variable bacterial cocci. BAL was positive for aspergillus antigen. He was started on voriconazole and his respiratory status improved until 2 weeks later when he became acutely hypoxic. Repeat bronchoscopy revealed necrotic tissue obstructing his bilateral mainstem bronchi. This was thought to represent remnants of pseudomembranes that were lodged in the main airways. The tracheobronchial tree was re-examined after cryotherapy and the pseudomembranes had resolved. The patient later died after his family elected to peruse comfort-based measures.DISCUSSION: There is some uncertainty in the underlying cause of this patient's pseudomembrane formation. He had a positive aspergillus antigen, though pathology showed gram-variable bacterial colonies without fungal elements. He was treated broadly with both antibiotics and antifungal therapy and had resolution of the pseudomembranes. In our case, there is a possibility that the bacteria found on pathology were contributing to the pseudomembranes, however based on literature review this is less likely.Invasive tracheobronchial aspergillosis (ITBA) is a rare presentation of aspergillus infection in the severely immunocompromised. Of all invasive aspergillus cases, ITBA is present in approximately 10%, with pseudomembrane formation in about 70% of these(1). Our patient's clinical decline was largely due the extensive obstruction from pseudomembrane production. There are few reports in the literature describing airway obstruction related to this pathology. There is no consensus on bronchoscopic management for these cases, but debridement with cryotherapy has been described.CONCLUSIONS: This case describes a rare but deadly complication of tracheobronchial pseudomembrane formation. Airway obstruction from pseudomembranes can occur and bronchoscopic debridement with cryotherapy may be a helpful tool in the treatment of these patients.Reference #1: Majima S, Okachi S, Asano M, et al. Pseudomembranous Invasive Tracheobronchial Aspergillosis with Fulminant Hepatitis and Hemophagocytic Syndrome. Intern Med. 2018;57(16):2371-2375. doi:10.2169/internalmedicine.9673-17Reference #2: 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.2010.25.9.1384Reference #3: Katayama S, Tonai K, Minakata D, Nunomiya S. Pseudomembranous Invasive Tracheobronchial Aspergillosis. Am J Respir Crit Care Med. 2022;205(3):e6-e7. doi:10.1164/rccm.202009-3659IMDISCLOSURES: No relevant relationships by Matthew HuangNo relevant relationships by Alexys MonosonNo relevant relationships by Shilpa Sridhar SESSION TITLE: Infectious Complications with Obstructions and Connections SESSION TYPE: Case Reports PRESENTED ON: 10/17/2022 03:15 pm - 04:15 pm INTRODUCTION: Tracheobronchial pseudomembranes are thick, tissue-like films comprised of endobronchial mucous production and sloughing of necrotic mucosal epithelium in response to infection, trauma, or aspiration (2). Of the infectious etiologies aspergillus is most cited in the literature (3). A feared complication of pseudomembrane development is airway obstruction, which is described in this case. CASE PRESENTATION: A 58-year-old male with a history of relapsed diffuse large B cell lymphoma presented with neutropenic fevers and bilateral consolidations on chest CT. He was started on broad spectrum antibiotics, but his respiratory status declined requiring intubation. Bronchoscopy showed diffuse pseudomembranes with partial obstruction of the major airways that were removed with cryotherapy. Pathology showed pseudomembrane formation with membrane-like fibrin fragments and multiple gram-variable bacterial cocci. BAL was positive for aspergillus antigen. He was started on voriconazole and his respiratory status improved until 2 weeks later when he became acutely hypoxic. Repeat bronchoscopy revealed necrotic tissue obstructing his bilateral mainstem bronchi. This was thought to represent remnants of pseudomembranes that were lodged in the main airways. The tracheobronchial tree was re-examined after cryotherapy and the pseudomembranes had resolved. The patient later died after his family elected to peruse comfort-based measures. DISCUSSION: There is some uncertainty in the underlying cause of this patient's pseudomembrane formation. He had a positive aspergillus antigen, though pathology showed gram-variable bacterial colonies without fungal elements. He was treated broadly with both antibiotics and antifungal therapy and had resolution of the pseudomembranes. In our case, there is a possibility that the bacteria found on pathology were contributing to the pseudomembranes, however based on literature review this is less likely. Invasive tracheobronchial aspergillosis (ITBA) is a rare presentation of aspergillus infection in the severely immunocompromised. Of all invasive aspergillus cases, ITBA is present in approximately 10%, with pseudomembrane formation in about 70% of these(1). Our patient's clinical decline was largely due the extensive obstruction from pseudomembrane production. There are few reports in the literature describing airway obstruction related to this pathology. There is no consensus on bronchoscopic management for these cases, but debridement with cryotherapy has been described. CONCLUSIONS: This case describes a rare but deadly complication of tracheobronchial pseudomembrane formation. Airway obstruction from pseudomembranes can occur and bronchoscopic debridement with cryotherapy may be a helpful tool in the treatment of these patients. Reference #1: Majima S, Okachi S, Asano M, et al. Pseudomembranous Invasive Tracheobronchial Aspergillosis with Fulminant Hepatitis and Hemophagocytic Syndrome. Intern Med. 2018;57(16):2371-2375. doi:10.2169/internalmedicine.9673-17 Reference #2: 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 Reference #3: Katayama S, Tonai K, Minakata D, Nunomiya S. Pseudomembranous Invasive Tracheobronchial Aspergillosis. Am J Respir Crit Care Med. 2022;205(3):e6-e7. doi:10.1164/rccm.202009-3659IM DISCLOSURES: No relevant relationships by Matthew Huang No relevant relationships by Alexys Monoson No relevant relationships by Shilpa Sridhar

A CASE OF RECURRENT POST-EXTUBATION OBSTRUCTIVE FIBRINOUS TRACHEAL PSEUDOMEMBRANE FORMATION

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Obstructive Fibrinous Tracheal Pseudomembrane (OFTP) is a very rare complication seen after short term intubation; as such, a real incidence rate has not been reported in the literature. In case reports and case reviews though, it has been widely accepted that bronchoscopic intervention with removal of the pseudomembrane(s) is curative1. This vignette is the first documented case of recurrent post-extubation OFTP formation requiring multiple therapeutic bronchoscopies and, eventually, cryotherapy. CASE PRESENTATION: The patient is a 78-year-old female with multiple comorbidities who was hospitalized for urosepsis. Her course was complicated by acute respiratory failure secondary to pulmonary edema requiring endotracheal intubation. A week after extubation, she developed dyspnea and stridor that did not improve with steroids and racemic epinephrine. Laryngoscopy was performed and was unrevealing. CT scan of the neck demonstrated a 1.2 cm polypoid tracheal mass at the thoracic inlet. Flexible bronchoscopy allowed for removal of the mass which was histologically consistent with OFTP and her respiratory status returned to baseline. Several days after hospital discharge, she again presented with dyspnea and stridor. Bronchoscopy again revealed an obstructing pseudomembrane that was removed and her respiratory symptoms improved temporarily. She underwent two subsequent bronchoscopies over the next week, both of which verified the presence of obstructing pseudomembranes requiring removal. The patient did not have a recurrence of OFTP after undergoing endotracheal cryotherapy during her final bronchoscopic procedure. DISCUSSION: This case demonstrates the importance of considering OFTP in the differential for post-extubation stridor and dyspnea because the treatment differs from more common causes of post-extubation stridor such as laryngeal edema, tracheo- or broncho-malacia, or vocal cord dysfunction. OFTP requires bronchoscopic intervention, while the other causes may be treated more conservatively. Prevention of OFTP can be achieved by maintaining an appropriate cuff pressure of < 25 mmHg since the underlying pathology is thought to stem from direct contact of the ET tube cuff with the tracheal mucosa1. In theory, difficult intubations and episodes of self-extubation are considered to be risk factors for the development of OFTP, as these can inflict more trauma to the airway as the cuff is still inflated and shear forces are applied to the upper airway2. CONCLUSIONS: OFTP should always be considered as a cause of stridor and early bronchoscopic intervention is paramount. It is also equally important to emphasize prevention of this complication. Appropriate preventative measures include maintaining appropriate sedation to prevent self-extubation, maintaining appropriate cuff pressures, and emphasizing early extubation. Reference #1: Lins, M., Dobbeleir, I., Germonpré, P., Waelput, W., Pauwels, P. and Jorens, P. (2010). Postextubation Obstructive Pseudomembranes: A Case Series and Review of a Rare Complication After Endotracheal Intubation. Lung, 189(1), pp.81-86. Reference #2: Y. Ammar, J. Vella-Boucaud, C. Launois, H. Vallerand, S. Dury, F. Lebargy, et al. Obstructive Fibrinous Tracheal Pseudomembrane Anesth. Analg. 2017 Jul;125(1):172-175 DISCLOSURES: No relevant relationships by Calli Bertschy, source=Web Response No relevant relationships by George McKenney, source=Web Response

Rare Complication Of Orotracheal Intubation: Obstructive Fibrinous Tracheal Pseudomembrane, About A Case And Review Of The Literature

We report a case of obstructive fibrinous tracheal pseudomembrane as being complication of endotracheal intubation in a 73 year-old woman, whose particularities are: The non-urgent clinical presentation with non-specific symptoms, the biopsy with anatomopathological study exceptionally found in the literature for the same case and the favorable evolution under medical treatment without recourse to the interventional bronchoscopy which represents the treatment the most frequent and the most effective of this affection.

Obstructive Fibrinous Tracheal Pseudomembrane.

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare and potentially severe complication of endotracheal intubation characterized by a tubular pseudomembrane that obstructs the trachea and induces clinical symptoms of airway obstruction after extubation. In this report, we reviewed and summarized all published cases of OFTP (n = 58) between 1981 and 2015. Twenty-three of 52 patients were men, and the mean age was 36 ± 22 years. Intubation was emergent in 41 of 53 cases. OFTP was revealed by acute symptoms in 19 of 39 cases and led to acute respiratory failure in 13 of 39 cases. Symptoms occurred 3 ± 3 days after extubation. A tracheal obstruction ≥70% was observed in 14 of 18 cases. Bronchoscopic removal was performed in 49 of 58 cases with no recurrence. In conclusion, OFTP is characterized by a typical clinical and endoscopic presentation, with no recurrence after bronchoscopic removal. Early recognition and bronchoscopy are key elements for efficient diagnosis and treatment.

Obstructive Fibrinous Tracheal Pseudomembrane: A Very Rare and Life-Threatening Complication of the Endotracheal Intubation

Obstructive Fibrinous Tracheal Pseudomembrane: A Very Rare and Life-Threatening Complication of the Endotracheal Intubation

Obstructive Fibrinous Tracheal Pseudomembrane After Endotracheal Intubation.

Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the PubMed and EmBase databases for all the cases describing OFTP. The systematic search yielded 28 citations describing 53 subjects with OFTP. The study population (61.1% females) comprised of both adults and pediatric subjects with a median (IQR) age of 40.5 (14.8-60.5) years. The median (IQR) size of endotracheal tube was 7.5 (6-9.3) mm with a median (IQR) duration of intubation of 36 (14-96) hours. The median (IQR) time to onset of symptoms after extubation was 24 (6-96) hours. Stridor was the most common symptom. The average delay in correctly identifying the OFTP was 26 hours. The diagnosis of tracheal pseudomembrane was confirmed by flexible bronchoscopy in 38 (70.4%) instances while rigid bronchoscopy was used in 46.3% subjects for removing the pseudomembrane. There were two deaths, one each in an adult and a pediatric subject. OFTP is a complication of tracheal intubation and presents with respiratory failure. The diagnosis can be confirmed by flexible bronchoscopy. Treatment involves removal of the obstructing membrane with either flexible or rigid bronchoscopy.

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Obstructive fibrinous tracheal pseudomembrane (OFTP) is an airway complication that occurs after endotracheal intubation. It originates from superficial mucosal abrasion and desquamation of necrotic tracheal epithelium at the site of cuff pressure. This condition is a rare cause of postextubation stridor. We present a case of postextubation stridor secondary to OFTP, resulting in clinical features of upper airway obstruction > 8 h after extubation. The case features complete obstruction at the tip of the endotracheal tube from OFTP.

Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

Obstructive Fibrinous Tracheal Pseudomembrane: An Update

See the letter "Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis" in volume 29 on page 110.

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Obstructive fibrinous tracheal pseudomembrane (OFTP) is an airway complication that occurs after endotracheal intubation. It originates from superficial mucosal abrasion and desquamation of necrotic tracheal epithelium at the site of cuff pressure. This condition is a rare cause of postextubation stridor. We present a case of postextubation stridor secondary to OFTP, resulting in clinical features of upper airway obstruction > 8 h after extubation. The case features complete obstruction at the tip of the endotracheal tube from OFTP.

Obstructive Fibrinous Tracheal Pseudomembrane

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a relatively rare cause of failed extubation. OFTP may be more common than described in the literature. OFTP results from ischemic injury to tracheal mucosa and may be the initial stage of the development of tracheal stenosis. Early diagnosis and treatment can prevent re intubation and mortality. We present a rare case of OFTP. The patient was intubated for 3 days for asthma exacerbation and was appropriately discharged. The patient was seen the second time in the emergency room and was treated for asthma exacerbation on the same day. Because of persistent symptoms after 3 days, CT scan of the chest was performed, which indicated necrotizing tracheitis with gas formation within the tracheal wall. Bronchoscopy showed no evidence of necrosis, but there was a thick white plaque toughly adherent to the tracheal wall.

A very early stage of obstructive fibrinous tracheal pseudo-membrane formation.

As result of a short-term intubation (24 hours), we report a rare and poorly known complication: the formation of an obstructive fibrinous tracheal pseudo-membrane (OFTP). The diagnosis and therapy of OFTP were due to its spontaneous expectoration after a long asymptomatic time post extubation (four days): This is a very unusual event. A CT-scan of the chest performed 3 hours after intubation revealed the first step of pseudo-membrane developing.

Reply to Anile et al.

We appreciate the interest showed by Anile et al. [1] in our article. We thank the authors for sharing their experience with four cases of obstructive fibrinous tracheal pseudomembrane (OFTP) removed by rigid bronchoscopy (RB) [2] and for the opportunity to clarify some of the key points regarding such issues. First, OFTP is a diagnostic challenge. In most cases, it is misdiagnosed as benign post-intubation tracheal stenosis, and the patient is referred to the thoracic surgery unit for endoscopic and/or surgical treatment. Chest CT scans show a tracheal stenosis without radiological signs for which pseudomembrane may be suspected, while its observation during flexible bronchoscopic (FB) is difficult for the reasons reported by the same authors [2]. However, last week we performed an FB in a patient who had tracheostomy. The patient presented with acute respiratory failure. We found an annular lesion with a septum that was partially torn and downwardly detached with obstruction of tracheal lumen. Remembering our previous experience, a diagnosis of OFTP was made. Thus, we believe that pseudomembrane is considered as a rare event because it is poorly known, but it might be much more common than thought. Stridor and respiratory failure are common findings after extubation due to a variety of causes. Thus, pseudomembranes may be detached and removed by tracheal suctioning and/or reintubation, and thus might remain unrecognized [3]. Secondly, the pathogenesis of OFTP remains unclear. Deslee et al. [4] postulated that ischaemic injury due to pressure at the site of the endotracheal cuff is the first step of developing pseudomembrane. However, formation of pseudomembrane has been associated with various other conditions including pulmonary infection, traumatic intubation, aspiration of gastric contents, diabetic microcirculation changes as reported by Talwar et al. [5]. Two of the four cases reported by the authors [2] had Candidal infection. However, it would be interesting to know whether the other two patients presented other predisposing factors for development of pseudomembrane. In our patient, in theory, the traumatic intubation may cause superficial damage to tracheal mucosa that, in addition to injury due to endotracheal cuff, develops pseudomembrane. Conversely, real tracheal ischaemic injury at the site of intubation, resulting from more profound tissue injury may lead to stenosis afterward [3]. Whether the use of marijuana is a risk factor of OFTP remains to be validated. Thirdly, we agree with the authors that the removal of pseudomembrane should be performed via RB. It allows the extraction of it in one piece while maintaining sufficient ventilation during the procedure. Lins et al. [3] in a recent review reported that, in only 4 of 22 cases, the ablation of membrane was made during FB. No case was reported by the authors [3] in which pseudomembrane was spontaneously coughed up to confirm that our case is unique in literature. In closure, OFTP should always be considered in the differential diagnosis of OFTP that requires immediate treatment. However, if you have experienced previous episodes of pseudomembrane, it will help you in diagnosing new cases in the future!

Obstructive Fibrinous Tracheal Pseudomembrane

Obstructive fibrinous tracheal pseudomembrane is a rare but potentially fatal complication associated with endotracheal intubation. Little is known about the mechanisms that play a role in the development of tracheal pseudomembrane, but it requires early diagnosis and treatment to prevent its major consequences. In this report, we present a case of obstructive fibrinous tracheal pseudomembrane, which developed a day after extubation in a patient who was intubated for 2 days. Therapeutic bronchoscopy was highly successful in removing the lesion and improving the clinical course.

Clinical Experience of Rigid Bronchoscopy in Single Center

BackgroundThe aim of this study was to analyze clinical situations requiring rigid bronchoscopy and evaluate usefulness of rigid bronchoscopic intervention in benign or malignant airway disorders.MethodsWe retrospectively reviewed 29 patients who underwent rigid bronchoscopy from November 2007 to February 2011 at St. Paul's Hospital, The Catholic University of Korea School of Medicine.ResultsOf the 29 patients, the most frequent underlying etiology was benign stenosis of trachea (n=20). Of those 20 patients, 16 had post-intubation tracheal stenosis (PITS), 2 had tracheal stenosis due to inhalation burn (IBTS) and other 2 had obstructive fibrinous tracheal pseudomembrane (OFTP). Other etiologies were airway malignancy (n=6), endobronchial stenosis due to tuberculosis (n=2), and foreign body (n=1). For treatment, silicone stent insertion was done in 16 cases of PITS and IBTS and mechanical removal was performed in 2 cases of OFTP. In 6 cases of malignant airway obstruction mechanical debulking was performed and silicone stents were inserted additionally in 2 cases. Balloon dilatation and electrocautery were used in 2 cases of endobronchial stenosis due to tuberculosis. In all cases of stent, airway obstructive symptom improved immediately. Granulation tissue formation was the most common complication.ConclusionTracheal stenosis was most common indication and silicone stenting was most common procedure of rigid bronchoscopy in our center. Rigid bronchoscopic procedures, at least tracheal silicone stenting, should be included in pulmonary medicine fellowship programs because it is a very effective and indispensable method to relieve critical airway obstruction which needs training to learn.

Post-intubation membranous trachitis after endotracheal intubation

We read with interest the paper entitled ‘Spontaneous expectoration of an obstructive fibrinous tracheal pseudomembrane after tracheal intubation’ from Fiorelli et al .[ 1]. Membraneous trachitis is a rare complication after tracheal intubation; however, it may pose several diagnostic and therapeutic problems if misdiagnosed. In particular, both benign tracheal strictures and simple granulation may be erroneously suspected. Direct endoscopic observation may be difficult due either to the presence of the endotracheal tube in place, or, in the case of spontaneously breathing patients, to respiratory distress. Radiological evaluation with computed tomography (CT) may also be difficult for the same reasons. We have observed this complication in four patients during the last years. In all cases, the intubation time was less than a week long and the suspect of tracheal obstruction was raised on the base of difficulties to extubate the patient notwithstanding optimal functional parameters. In all patients, inexperienced endoscopists made the diagnosis of fibrous tracheal strictures; in one case, the erroneous diagnosis was confirmed at CT performed with the patient still intubated. All patients were still intubated when they were referred with the diagnosis of ‘benign postintubation tracheal stricture’ to our unit for a more careful endoscopic evaluation through the rigid bronchoscope, potential initial treatment with mechanical debridement and/or laser, and subsequent tracheal or laryngo-tracheal resection [2]. In all cases, the thick fibrous membranes required careful mechanical debridement to be removed with the tip of the rigid bronchoscope, with the patient under deep sedation and spontaneously breathing; after the removal of the pseudomembranes, a bleeding airway wall was observed. All the lesions were at the level of the tracheal tube cuff. All patients were immediately extubated. Cultures showed the presence of Candida in two cases. After 1 month, fiberoptic bronchoscopy showed complete mucosal healing. This complication should always be suspected when extubation is not possible after short periods of mechanical ventilation notwithstanding adequate functional parameters. Bronchoscopy should be performed by an experienced thoracic surgeon familiar with tracheal disorders; the rigid bronchoscope should always be available for immediate treatment. Spontaneous expectoration is extremely rare due to adhesions with the tracheal wall, as reported by Fiorelli A et al. CT evaluation is not useful.

Pediatric obstructive fibrinous tracheal pseudomembrane—Characteristics and management with flexible bronchoscopy

Objective To evaluate the incidence, characteristics, flexible bronchoscopy (FB) findings, interventions and outcome of pediatric obstructive fibrinous tracheal pseudomembrane (OFTP) in our pediatric and neonatal intensive care units (ICUs). Patients and methods This is a retrospective study of medical and FB video records in a single tertiary university-affiliated teaching hospital over a ten-year period. Data was collected from patients who were admitted and extubated of endotracheal tube in the ICUs with a FB diagnosis of an OFTP-like lesion. The associated medical information, FB interventions and video records were reviewed and analyzed. Results Eight patients with OFTP were enrolled, with an incidence rate of 1.48% in the postextubation respiratory distress patients. Mean age was 32 ± 32 months (range, 2 months to 13 years); mean body weight was 13.7 ± 8.1 kg (range, 4.3–45 kg); mean intubation period was 37.6 ± 12.3 h; mean time for symptoms to develop after extubation was 3.6 ± 1.4 h. Symptoms lasted for 20.8 ± 20.3 h before FB examination. All patients were accurately diagnosed with OFTP at the first postextubation FB examination and revealed various morphologies. The estimated cross-sectional tracheal lumen was reduced by 70–90% and the mean length of lesion was 18.1 ± 5.2 mm (range, 10–30 mm). All OFTP were successfully ablated immediately after the diagnosis in one FB session by using various techniques and without any complication. Total duration for both diagnostic and interventional FB was 19.4 ± 2.5 min. No recurrence was noted thereafter. Conclusions OFTP should always be considered in the event of postextubation respiratory distress, especially in the pediatric and neonatal ICUs. Early diagnosis and effective ablation can be achieved with aid of FB.