Prevention of Airway Fires

Remz, Matthew; Luria, Isaac; Gravenstein, Michael; Rice, Stephen K.; Morey, Timothy E.; Gravenstein, Nikolaus; Rice, Mark J.

doi:10.1213/ane.0b013e318298a692

Cited by 25 publications

(3 citation statements)

References 10 publications

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“… 12 , 13 It is possible that FiO 2 at the surgical site may be higher than the measured inspired and expired oxygen levels. Remz et al 14 found that it took up to eight minutes for expiratory oxygen to reach 30% after dropping FiO2 to 0.3 if pre‐oxygenation was performed with 1.0 FiO 2 . Although end‐tidal control modes accelerate this process, oxygen content at the cauterization site remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Establishing the Ideal Conditions to Create an Airway Fire Using a Porcine Airway Model

et al. 2023

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Objective Airway fires are a rare but devastating complication of airway surgery. Although protocols for managing airway fires have been discussed, the ideal conditions for igniting airway fires remain unclear. This study examined the oxygen level required to ignite a fire during a tracheostomy. Study Design Porcine Model. Setting Laboratory. Methods Porcine tracheas were intubated with a 7.5 air‐filled polyvinyl endotracheal tube. A tracheostomy was performed. Monopolar and bipolar cautery were used in independent experiments to assess the ignition capacity. Seven trials were performed for each fraction of inspired oxygen (FiO 2 ): 1.0, 0.9, 0.7, 0.6, 0.5, 0.4, and 0.3. The primary outcome was ignition of a fire. The time was started once the cautery function was turned on. The time was stopped when a flame was produced. Thirty seconds was used as the cut‐off for “no fire.” Results The average time to ignition for monopolar cautery at FiO 2 of 1.0, 0.9, 0.8, 0.7, and 0.6 was found to be 9.9, 6.6, 6.9, 9.6, and 8.4 s, respectively. FiO 2 ≤ 0.5 did not produce a flame. No flame was created using the bipolar device. Dry tissue eschar shortened the time to ignition, whereas moisture in the tissue prolonged the time to ignition. However, these differences were not quantified. Conclusion Dry tissue eschar, monopolar cautery, and FiO 2 ≥ 0.6 are more likely to result in airway fires.

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Section: Discussionmentioning

confidence: 99%

Establishing the Ideal Conditions to Create an Airway Fire Using a Porcine Airway Model

et al. 2023

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“…The inspired oxygen concentration should be <50% while maintaining patient's oxygen saturation within normal range, especially in the procedures involving electrocautery close to ETT. [ 7 8 ]…”

Section: Discussionmentioning

confidence: 99%

Airway fires during surgery: Management and prevention

Akhtar¹,

Ansar²,

Baig³

et al. 2016

J Anaesthesiol Clin Pharmacol

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Airway fires pose a serious risk to surgical patients. Fires during surgery have been reported for many years with flammable anesthetic agents being the main culprits in the past. Association of airway fires with laser surgery is well-recognized, but there are reports of endotracheal tube fires ignited by electrocautery during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially grave consequences. While airway fires are relatively uncommon occurrences, they are very serious and can often be fatal. Success in preventing such events requires a thorough understanding of the components leading to a fire (fuel, oxidizer, and ignition source), as well as good communication between all members present to appropriately manage the fire and ensure patient safety. We present a case of fire in the airway during routine adenotonsillectomy. We will review the causes, preventive measures, and brief management for airway fires.

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“…In unilateral endobronchial involvement, it is important to preserve the contralateral side by intermittently aspirating blood and mucus and removing dislocated debris. To reduce the risk of airway fire, an inspiratory oxygen concentration of less than ≤0.4 is targeted [39], which is often problematic in hypoxic patients. Thermal therapies should not be initiated until the inspiratory and expiratory FiO 2 are within the tolerable range.…”

Section: Endobronchial Recanalization Techniquesmentioning

confidence: 99%

Anesthesia for interventional pulmonology

Semmelmann

Loop

2021

Current Opinion in Anaesthesiology

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Purpose of reviewAnesthesia for pulmonological interventions is a demanding challenge. This article discusses recent innovations and the implications for periinterventional anesthetic management. Recent findingsInterventional pulmonology is a rapidly expanding specialty with very complex diagnostic and therapeutic approaches that include oncological staging, treatment of obstructive and restrictive lung diseases, recanalization of endobronchial obstructions, and retrieval of foreign bodies. With the development of advanced diagnostic and therapeutic interventions, the application is extended to critically ill patients. Current evidence focusing on the anesthetic techniques is presented here.

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Prevention of Airway Fires

Cited by 25 publications

References 10 publications

Establishing the Ideal Conditions to Create an Airway Fire Using a Porcine Airway Model

Establishing the Ideal Conditions to Create an Airway Fire Using a Porcine Airway Model

Airway fires during surgery: Management and prevention

Anesthesia for interventional pulmonology

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