Airway fire during tracheostomy

What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room

“…Fires have been reported during tracheostomy, adenotonsillectomy, endoscopic airway surgery and cutaneous surgery of the head and neck [1][2][3][4][5]. We recently surveyed members of the American Academy of Otolaryngology-Head and Neck Surgery and found that 25% of surgical fires occurred during oropharyngeal surgery, and in particular adenotonsillectomy performed with a monopolar electrosurgical device (Bovie) [6].…”

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

“…with diathermy coming into contact with 100% oxygen in the airway [2,3,7]. The type of monopolar diathermy does not seem to matter, with cases reported where cutting, coagulation or blend modes were used [8].…”

“…Airway fires appear to be less common when diathermy is used. However, the ASA Practice Advisory on operating room fires [1] lists electrosurgical or electrocautery devices as possible ignition sources, based on tracheostomy case reports in the literature [2,3]. The incidence of diathermyrelated airway fire has not been quantified and there have been no reports of fires occurring during transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).…”

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

“…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.…”