Airway fire due to diathermy during tracheostomy in an intensive care patient

Abstract

We describe a case of airway fire in an 83-year-old, critically ill patient. The fire occurred during a surgical tracheostomy under general anaesthesia, following ignition of the tracheal tube by diathermy. After debridement of the burnt tissue and treatment with intravenous antibiotics and glucocorticoids, the patient's respiratory function worsened initially. The patient eventually recovered without long-term sequelae and was discharged from the intensive care unit. The circumstances of this and other similar incidents are reviewed, as are the suggested methods for preventing this frightening occurrence.

A tubeless anaesthetic technique for paediatric laryngeal laser surgery

“…Fire requires three elements for its creation, a source of fuel (charred tissue, uncovered endotracheal tube, drapes), oxygen (from anaesthetic supply) and a source of heat (laser, diathermy). Fire has been well documented in the use of laser [3] and diathermy [4]. Whilst flammable anaesthetic gasses are no longer used, the anaesthetic tube poses a risk of combustion.…”

Intra‐oral ignition of monopolar diathermy during transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE)

“…One to five minutes should elapse between reducing F I O 2 and using diathermy, and consideration should be given to scavenging gases from the oral cavity with a suction device before diathermy. Nonetheless, reducing F I O 2 will not necessarily prevent an airway fire (tracheal tube ignition with F I O 2 0.25 has been reported [9]), so constant vigilance remains necessary when THRIVE is used. Notably, the needle diathermy manufacturers recommend using a plastic gum guard when there is any metal in or near the oral cavity, yet this is not readily accessible in most hospitals within the UK (K. El-Boghdadly, personal communication).…”

Flooding With Carbon Dioxide Prevents Airway Fire Induced by Diathermy During Open Tracheostomy

“…Some of these measures are not always easy to implement or not without drawbacks. For example, some surgeons prefer diathermy to scalpels, [1][2][3][4][5][6][7][8][9][10]13,14 especially in patients with hemostatic deficiencies; even if a scalpel is used to incise the trachea, diathermy may be required to secure hemostasis 11,12 ; some critically ill patients, precisely those who require tracheostomy, may not tolerate apnea or the use of low concentrations of O 2 ; tracheal extubation before a definitive airway is established is dangerous 9,15 ; leak around an uncuffed ETT (in children) in situ may be difficult to avoid; and, depending on the tracheostomy site, positioning the ETT cuff between it and the carina to avoid accidental puncture can be cumbersome and difficult. We have devised a novel technique that appears to have little or no disadvantages and that may be effective in preventing and extinguishing fire.…”

“…13,14 Many recommendations have been made to prevent and to put out fire if one should occur, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] including avoidance of diathermy during and after entry into the tracheal lumen, cessation of ventilation, avoidance of high concentrations of oxygen (O 2 ), premature removal of the endotracheal tube (ETT), ensuring that the ETT cuff is caudal to the site of tracheostomy, etc. Some of these measures are not always easy to implement or not without drawbacks.…”

“…F ire during tracheostomy is rare but may result in serious airway injury [1][2][3][4][5][6][7][8][9][10][11][12] and possible death. 13,14 Many recommendations have been made to prevent and to put out fire if one should occur, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] including avoidance of diathermy during and after entry into the tracheal lumen, cessation of ventilation, avoidance of high concentrations of oxygen (O 2 ), premature removal of the endotracheal tube (ETT), ensuring that the ETT cuff is caudal to the site of tracheostomy, etc.…”