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Airway fire during awake tracheostomy using high‐flow nasal oxygen

Airway fire during awake tracheostomy using high‐flow nasal oxygen High‐flow nasal oxygen is increasingly used in complex head and neck surgical procedures and difficult airway management. We describe a case where an operating room fire occurred while using high‐flow nasal oxygen during an awake tracheostomy for an obese patient in airway extremis due to supraglottitis. Shortly after the operation began, and before incision of the trachea, electrical diathermy applied to bleeding sub‐cutaneous vessels ignited a small flame. This was extinguished without harm to the patient and the procedure was completed without further complication. Fire requires three components: fuel; heat; and an oxidiser. We speculate that high‐flow oxygen channelled under the drapes and acted as the oxidiser; either tissue eschar or vapourised fat were the fuel; and the diathermy supplied a source of ignition to complete the fire triad. When using high flows of concentrated oxygen, practitioners should aim to minimise all of these factors and be alert for the risk of fire at every stage of the operation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Airway fire during awake tracheostomy using high‐flow nasal oxygen

Adams, T. R. P.; Ricciardelli, A.
Anaesthesia Reports , Volume 8 (1) – Jan 1, 2020
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Publisher
Wiley
Copyright
2020 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12038
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Abstract

High‐flow nasal oxygen is increasingly used in complex head and neck surgical procedures and difficult airway management. We describe a case where an operating room fire occurred while using high‐flow nasal oxygen during an awake tracheostomy for an obese patient in airway extremis due to supraglottitis. Shortly after the operation began, and before incision of the trachea, electrical diathermy applied to bleeding sub‐cutaneous vessels ignited a small flame. This was extinguished without harm to the patient and the procedure was completed without further complication. Fire requires three components: fuel; heat; and an oxidiser. We speculate that high‐flow oxygen channelled under the drapes and acted as the oxidiser; either tissue eschar or vapourised fat were the fuel; and the diathermy supplied a source of ignition to complete the fire triad. When using high flows of concentrated oxygen, practitioners should aim to minimise all of these factors and be alert for the risk of fire at every stage of the operation.

Journal

Anaesthesia Reports – Wiley

Published: Jan 1, 2020

Keywords: airway fire; high‐flow nasal oxygen; peripheral oxygen delivery; tracheostomy

References

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    Ffrench‐O'Carroll, R; Fitzpatrick, K; Jonker, WR; Choo, M; Tujjar, O
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    Thurairatnam, R; Arora, A; Mir, F
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    Greenland, K
  • Safe use of high‐flow nasal oxygen (HFNO) with special reference to difficult airway management and fire risk
    Cooper, J; Griffiths, B; Ehrenwerth, J
  • Intra‐oral ignition of monopolar diathermy during transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE)
    Onwochei, D; El‐Boghdadly, K; Oakley, R; Ahmad, I
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    Weber, S; Hargunani, C; Wax, M
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    Gorphe, P; Sarfati, B; Janot, F
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    Rogers, ML; Nickalls, RWD; Brackenbury, ET; Salama, FD; Beattie, MG; Perks, AGB