- For (airway) fire to occur, one requires the presence of the unholy triad of:
- An ignition source e.g. surgical LASER, defibrillator pads
- An oxidiser e.g. oxygen, nitrous oxide
- A fuel source e.g. endotracheal tube, surgical drapes, dry gauze/gamgee
Airway Fire
Airway Fire
Resources
- Airway fires are rare events, though perhaps more common than anticipated with an incidence of 50 - 200/yr in the USA
| Anaesthetic | Surgical/logistical |
| Keep FiO2 <0.3 | Avoid diathermy and LASER |
| Avoid N2O | If diathermy; bipolar > coag. mode unipolar > cutting unipolar |
| Tubeless technique or LASER-resistant ETT | Proper training of staff inc. LASER safety |
| Avoid open O2 delivery devices e.g. HFNO, facemask | Wet gauze/gamgee/surgical fuel sources |
| Maintain vigilance in high-risk procedures | Maintenance of equipment |
An airway fire is an anaesthetic emergency and I would call for senior anaesthetic support as well as making a rapid but thorough assessment of the patient
- Immediate priorities are to:
- Stop surgeon using LASER (ignition source)
- Stop the flow of all airway gases (oxidisers) and remove the endotracheal tube (fuel)
- Flood operating site with saline or water
- One should then proceed to re-establish ventilation e.g. using a BVM and an FiO2 as low as possible i.e. room air
- Maintain anaesthesia using a TIVA technique
- ENT surgeon to inspect airway with rigid bronchoscope to determine the degree of thermal injury and for the presence of debris
- Gentle BAL and fibreoptic assessment of distal airways is of benefit
- May need tracheostomy if severe upper-airway burns; consider re-intubating if not
Subsequent management
- Consider HDU/ICU admission to monitor both airway and for evolving ALI/ARDS
- Consider dexamethasone ± empirical antibiotics
- Document thoroughly in notes
- Critical incident form
- Team debrief
- Discuss at M&M
- If faulty equipment report to MHRA
- Life-threatening airway obstruction
- Disfiguring burns
- Severe inhalational injuries ± ARDS
- Infection