Risk of airway fire with the use of KTP laser and high flow humidified oxygen delivery in a laryngeal surgery model

Huang, Lucy; Badenoch, Adam; Vermeulen, Marthinus; Ullah, Shahid; Woods, Charmaine M.; Athanasiadis, Theodore; Ooi, Eng H.

doi:10.1038/s41598-021-04636-3

Cited by 12 publications

(12 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Short, intermittent use of laser in pulsed mode along with low O 2 levels is thought to be safe, with a low risk of ignition or fire. 13,14 To summarize, there are limited prospective data on physiological and vital parameters of the use of THRIVE in laryngeal surgeries in a larger adult population. No data exist on the use of THRIVE in lower oxygen concentrations that is, 30%, in adults.…”

Section: Introductionmentioning

confidence: 99%

“…Chang et al 13 demonstrated the risk of self‐sustained airway fires at oxygen concentrations >80% using a continuous wave fiber laser but noted episodes of ignition even at lower O 2 levels. Huang et al 14 showed the risk of sparks and flame when using the laser with high flow oxygen increases with higher delivered oxygen concentrations (>60%), continuous potassium‐titanyl‐phosphate (KTP) laser settings, charred tissue, and lasering adipose tissue. Short, intermittent use of laser in pulsed mode along with low O 2 levels is thought to be safe, with a low risk of ignition or fire 13,14 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Microlaryngeal Laser Surgery Using High‐flow Nasal Ventilation at Two Oxygen Concentration Deliveries

et al. 2022

View full text Add to dashboard Cite

Objectives Ventilation using 100% oxygenation creates a risk of fire during laser microlaryngeal surgery (MLS). The purpose of this study is to describe the technique of transnasal high‐flow ventilation using laser safe (30%) oxygen conditions, measure the intraoperative real‐time laryngeal oxygen concentration, and examine patient saturation status using this technique. Methods Prospective IRB approved study of patients undergoing tubeless laser MLS using high‐flow nasal oxygenation. Delivered oxygen concentration was reduced from 100% to 30% before lasering using an oxygen‐air blender then increased to 100% post‐laser procedure. Outcome measures included time for laryngeal oxygen concentration to equalize to laser safe levels; time to, methods of and duration of rescue ventilation; and desaturation rates and apnoeic times at both 100% and 30% oxygen deliveries. Results Fifty patients were recruited (mean age = 47.4 years). Mean laryngeal oxygen concentration (%) at 100% and 30% deliveries was 98.46 and 31.45, respectively. Mean (SD) of laryngeal oxygen concentration equalization time to 30% (seconds) was 9.4 (3.69). At 30% oxygen delivery desaturation rate was faster and apneic time shorter compared with 100%. Eighteen patients required rescue (jet) ventilation and they had a faster apneic desaturation rate (%/minute) than patients not requiring rescue. Mean (SD) apneic time (minutes) at 30% delivery was 4.56 (2.25) and 4.41 (2.18) in rescue versus non‐rescue groups respectively. BMI was the only significant predictor of desaturation rate at 30% oxygen delivery. Conclusion It is possible to achieve a safe time window for use of laser during MLS using transnasal humidified high‐flow ventilation by delivering 30% oxygen concentration. Level of Evidence 4 Laryngoscope, 133:634–639, 2023

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microlaryngeal Laser Surgery Using High‐flow Nasal Ventilation at Two Oxygen Concentration Deliveries

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Stuermer et al found in experimental models of fat, muscle, and cartilage that limiting laser use to intervals of 5 seconds in conditions of 50% oxygen or lower prevented fire from occuring 10 . Experiments with in vitro models suggest that reducing the oxygen concentration, using pulsed modes with low wattages, limiting lasing times, and eliminating certain endolaryngeal material can reduce the operative fire risk 11‐13 …”

mentioning

confidence: 99%

Safety and Utility of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) for Laser Laryngeal Surgery

Khan

Vukkadala

Saxena

et al. 2023

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

ObjectiveTransnasal humidified rapid‐insufflation ventilatory exchange (THRIVE) is gaining acceptance as a safe method for apneic ventilation and oxygenation during laryngeal procedures, but remains controversial during laser laryngeal surgery (LLS) due to the theoretical risk of airway fire. This study describes our experience with THRIVE during LLS.Study DesignRetrospective cohort study.SettingStanford University Hospital, October 15, 2015 to June 1, 2021.MethodsRetrospective chart review of patients ≥18 years who underwent LLS involving the CO2 or KTP laser with THRIVE as the primary mode of oxygenation.ResultsA total of 172 cases were identified. 20.9% were obese (BMI ≥ 30). Most common operative indication was subglottic stenosis. The CO2 laser was used in 79.1% of cases. Median lowest intraoperative SpO2 was 96%. 44.7% cases were solely under THRIVE while 16.3% required a single intubation and 19.2% required multiple intubations. Mean apnea time for THRIVE only cases was 32.1 minutes and in cases requiring at least one intubation 24.0 minutes (p < .001). Mean apnea time was significantly lower for patients who were obese (p < .001) or had a diagnosis of hypertension (p = .016). Obese patients and patients with hypertension were 2.03 and 1.43 times more likely to require intraoperative intubation, respectively. There were no intraoperative complications or fires since the institution of our LLS safety protocol.ConclusionBy eliminating the fuel component of the fire triangle, THRIVE can be safely used for continuous delivery of high FiO2 during LLS, provided adherence to institutional THRIVE‐LLS protocols.

show abstract

“…Finally, organic tissue models use tissues derived from outside the airway. 8 Given these limitations, the objective of this study was to design an organic airway tissue model to establish ideal conditions for starting an airway fire.…”

mentioning

confidence: 99%

“…Mannequin models allow for simulations that have structures closest to the human airway, but are not composed of organic tissue. Finally, organic tissue models use tissues derived from outside the airway 8 . Given these limitations, the objective of this study was to design an organic airway tissue model to establish ideal conditions for starting an airway fire.…”

mentioning

confidence: 99%

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

et al. 2023

View full text Add to dashboard Cite

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.

show abstract

Risk of airway fire with the use of KTP laser and high flow humidified oxygen delivery in a laryngeal surgery model

Cited by 12 publications

References 26 publications

Microlaryngeal Laser Surgery Using High‐flow Nasal Ventilation at Two Oxygen Concentration Deliveries

Microlaryngeal Laser Surgery Using High‐flow Nasal Ventilation at Two Oxygen Concentration Deliveries

Safety and Utility of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) for Laser Laryngeal Surgery

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

Contact Info

Product

Resources

About