Endotracheal Tube Fire Research Articles

Endotracheal tube fire during tracheostomy

Endotracheal tube fire during tracheostomy

Wire-reinforced endotracheal tube fire during tracheostomy -A case report-

Every operation could have a fire emergency, especially in the case of a tracheostomy. When a flammable gas meets a source of heat, the danger of fire is remarkable. A tracheal tube filled with a high concentration of oxygen is also a great risk factor for fire. Intra-tracheal tube fire is a rare, yet critical emergency with catastrophic consequences. Thus, numerous precautions are taken during a tracheostomy like, use of a special tube to prevent laser damage, ballooning of the tube with normal saline instead of air, and dilution of FiO2 with helium or nitrogen. Since the first recorded cases on tube fires, most of the fires were initiated in the balloon and the tip. In the present case report, however, we came across a fire incidence, which originated from the wire.

Endotracheal tube fires still happen – A short overview

Abstract Laser generated operating room fires have been reported ever since lasers have been used for therapeutic indications. This occurs because, when an ignition source such as the laser, is used in the vicinity of high oxygen concentrations, and materials, such as the endotracheal tube (ETT), can then be easily ignited. This paper shows examples of ETTs after such a fire, together with the severe injuries incurred. Even though over the years a great deal of experience has been collected in the management and handling of these patients, accidents with ETT fires still occur. Many different materials have been tested for ETTs with regard to their incendiary characteristics, and special constructions of ETTs for use with lasers have been developed accordingly. Whereas wrapping the ETT with metal foil gives a false sense of safety, the so-called ‘laser-tubes’ exhibit an increased resistance to damage by laser radiation. However, even using these, ETT fires have still occurred due to contamination with blood or because the laser has hit the connection of the cuff with the shaft of the tube. These particular aspects have recently been investigated, and international standards are being prepared, which will hopefully promote the development of proven laser-suited ETTs in an effort to reduce the frequency of these severe accidents.

Ignición del tubo endotraqueal durante cirugía laríngea. Análisis causa-raíz de un suceso centinela

Endotracheal tube fire during laryngeal surgery is a rare complication but one that has serious consequences. Surgeons, anesthesiologists and others involved with this type of surgery should become familiar with how to manage this difficult situation, which should be considered a sentinel event requiring prompt analysis of the root cause and surrounding circumstances. Measures to improve management should be implemented and training provided in order to prevent the recurrence of a similar unfortunate event. We report a case in which a patient's airway caught fire during use of an electrocautery device. The patient died as a result of the lesions sustained. We report the results of the investigation and the protocols for prevention and response implemented in our surgical department, in the hope that the experience will be of interest to others working in similar settings.

Ignición del tubo orotraqueal inducida por electrocauterio durante una traqueostomía

Endotracheal tube fire during surgery is a rare complication associated with carbon dioxide laser surgery and, less often, with electrocautery. We report a case in which tracheostomy was performed because of recurrence of a laryngeal tumor. During the procedure the endotracheal tube ignited when the lumen was opened with the electrocautery device.

Endotracheal Tube Fire during Tracheostomy: A Case Report

Electrosurgery in the presence of volatile anesthetic gases has been associated with operating-room fires. We report a case in which an operating-room fire occurred while an intubated patient underwent electrosurgical tracheostomy. The fire in this case was caused by a combination of an oxygen-rich environment, a polyvinyl chloride tube, and heat generated by an electrosurgical unit. We also discuss factors that increase the risk of this type of fire and the management steps that should be undertaken in the event that such a fire occurs, and we briefly review the literature on this subject.

Endotracheal Tube Fire: Comments on the Advisability of Not Extubating

Assistant Professor of AnesthesiaProfessor of AnesthesiologyUniversity of California–San Diego Medical CenterSan Diego, Californiajbenumof@ucsd.eduIn Reply:—Drs. Wolf and Sidebotham suggest that initial reventilation of the lung with air after extinguishing an airway fire based on the possibility that it may not be physically possible to inspect all potential reignition points, and initial reventilation with oxygen may rekindle fire in some of these points. We find that to be a reasonable suggestion (our initial reventilation was with oxygen) and would do so in the future.

Electrocautery-ignited endotracheal tube fire: case report

The risk of fire in the airway associated with laser surgery is well known, but there are reports of endotracheal tube fires ignited by electrocautery, particularly during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially devastating consequences. Surgeons undertaking these procedures should be aware of this complication and be familiar with measures to avoid them. We present a case report of an electrocautery-ignited endotracheal tube fire during an elective tracheostomy, which resulted in the patient’s death.

Effect of Saline-Filled or Viscous Lidocaine-Filled Cuff on the Laser-Induced Polyvinyl Chloride Endotracheal Tube Fires and Tidal Volume

Effect of Saline-Filled or Viscous Lidocaine-Filled Cuff on the Laser-Induced Polyvinyl Chloride Endotracheal Tube Fires and Tidal Volume

Electrocautery-ignited endotracheal tube fire: a case report

Electrocautery-ignited endotracheal tube fire: a case report

Metal anesthesia circuit components stop the progression of laser fires

Study Objective: To determine whether metallic Y-pieces and elbows would halt the progression of a laser-induced endotracheal tube fire. Design: A segment of polyvinyl chloride endotracheal tube was attached to either an all-plastic anesthesia circle breathing system (n = 5) or a circuit consisting of a metal Y-piece and elbow with plastic hoses (n = 5). In each case, an Nd-YAG laser was used to ignite the endotracheal tube segment and attached anesthesia circuit as 5 L/min of oxygen was flowing through them. Setting: Research laboratory of a university-affiliated metropolitan medical center. Measurements and Main Results: The flames from the endotracheal tubes burned through the 22 mm hoses that were part of the all-plastic circuits in 49.5 ± 8.8 seconds (mean ± SD). In none of the trials with the metal components did the fire advance beyond the endotracheal tube's 15 mm adapter. Conclusions: Metal circuit components halt the progression of laser-induced endotracheal tube fires toward the anesthesia machine.

Evaluation of foil coverings for protecting plastic endotracheal tubes from the potassium-titanyl-phosphate laser.

The potassium-titanyl-phosphate laser is being used for airway surgery and could cause an endotracheal tube fire. To determine whether five different metallic foil tapes or the Laser-Guard protective wrap would protect polyvinylchloride (PVC) endotracheal tubes from this laser, it was set to a power of 18 W and aimed at the wrapped endotracheal tube under study for up to 1 min while 5 L/min of oxygen flowed through the endotracheal tube. A plain (unwrapped) PVC endotracheal tube was studied also. The plain PVC endotracheal tube was ignited by the laser after 14 s. Potassium-titanyl-phosphate laser radiation did not significantly affect the nonadhesive sides of the foil tapes tested or the Laser-Guard covering. However, potassium-titanyl-phosphate laser radiation caused ignition or melting of underlying PVC endotracheal tubes when it was applied to the endotracheal tubes with the adhesive side of the foil tapes facing outward. It is concluded that only the Laser-Guard protective coating adequately protected the PVC endotracheal tubes tested under the conditions of this experiment.

Effects of the holmium:YAG and erbium:YAG lasers on endotracheal tubes.

Endotracheal tube (ET) fire is the most frequent complication arising with laser surgery in the upper aerodigestive tract. No data are available about the safety of commonly used ETs when used with recently developed high-energy pulsed lasers, working with only a minimal thermal component but mainly photoablative. A comparative in vitro study was performed with three types of endotracheal tubes to assess their resistance to wall and cuff damage by the laser beams of two pulsed infrared solid-state lasers. ET perforation was attempted with the erbium:YAG (lambda = 2,930 nm) and holmium:YAG (lambda = 2,120 nm) lasers. For all experiments, a repetition rate of 5 Hz was used. The 2.5-microseconds holmium:YAG pulses were coupled into a nylon fibre of 400 microns diameter. The 2.0-microseconds erbium:YAG laser pulses were applied to ETs through a lens system providing a spot size diameter of 200 microns. Polyvinyl chloride and silicon ET segments were exposed to laser pulse energies from 97 to 500 mJ in the presence of different anaesthetic gas mixtures. The time from the onset of exposure to tube perforation was recorded. Thermal gradients following laser application were measured. Laser exposure was continued for up to 90 s, unless tube ignition occurred. At all energy levels tested, the photo-ablative mechanism of laser-tube interaction, with few thermal components, led to laser-induced tube ignition if an FiO2 > 21% for the holmium:YAG and 34% for the erbium:YAG laser was established. With increasing pulse energies, ET segments ignited sooner. MLT tubes performed best in the present safety test.

Prevention of CO 2 laser—Induced endotracheal tube fires with the laser-guard protective coating

Study Objective: To determine how well Laser-Guard protects polyvinyl chloride (PVC) endotracheal tubes from the carbon dioxide (CO 2) laser. Design: Bare and Laser-Guard-protected PVC endotracheal tubes were tested with 5 L/min of oxygen (Oz) passing through them. Setting: Research laboratory of a university-affiliated metropolitan medical center. Interventions: After moistening the Laser-Guard-protected endotracheal tubes, we subjected the tubes to CO 2 laser radiation at 10 and 70 watts until combustion occurred or 60 seconds had elapsed. Measurements and Main Results: The bare PVC tube ignited and a “blowtorch” fire occurred after 3 seconds of CO 2 laser use at 70 watts. The moistened Laser-Guard-protected PVC endotracheal tubes were not significantly damaged by 1 minute of laser use at 70 watts. Conclusions: Laser-Guard protects the shafts of combustible PVC endotracheal tubes from direct, high-power, continuous CO 2 laser radiation.

Electrosurgery-Induced Endotracheal Tube Ignition during Tracheotomy

Electrosurgery was the most common source of ignition for operating room fires prior to the advent of lasers. When combined with volatile anesthetic mixtures, electrosurgery has caused ignition of plastic, rubber, paper, enteric gases, and combustible preparation solutions. We report on an intubated patient whose polyvinyl chloride endotracheal tube ignited during a tracheotomy performed with an electrosurgical unit. The oxygen-rich environment, the polyvinyl chloride tube, and the heat generated by the electrosurgical unit combined to produce a fire. Since otolaryngologists are called upon often to perform tracheotomies on intubated patients, it is imperative that they understand the factors involved in the development of such a fire. This case is presented with an explanation of why this type of fire occurs. A brief review of the literature is included. Different kinds of electrosurgical units, precautions as to their use, and the management of electrosurgery-induced endotracheal tube fires are also discussed.

Anesthetic Management of Patients Undergoing Endoscopic Laser Surgery

Summary Endoscopic laser surgery offers the surgeon new capabilities in treating airway disease. Laser devices now come in a variety of forms, with newer technology offering fine tuning for different surgical applications. Specifically, endoscopic laser surgery allows the surgeon access to the field without any kind of obstructive instrumentation. However, this new technology offers anesthesia practitioners new challenges. How does one share the patient’s airway with the surgeon, protect that airway, and offer adequate anesthesia while not obstructing surgical access to the operating field? Most commonly, the patient’s airway is protected by employing either a metal endotracheal tube or a modification of currently available endotracheal tubes in order to reduce the likelihood of laser-induced endotracheal tube fires and other complications. In addition, Venturi jet ventilation through an operating laryngoscope allows entrainment of an oxygen-air mixture for patient ventilation while minimizing any kind of foreign object in the surgical airway. As has been detailed in this article, there is no perfect anesthetic management technique available. Every new modification offers subtle advantages and differences over techniques previously available but also has one or more unwanted complications associated with its use. The safe anesthetic management of the patient undergoing endoscopic laser surgery requires considerable agility and flexibility by the anesthesia practitioner in order to adapt to rapid changing surgical needs and to provide a safe anesthetic for a patient undergoing a somewhat complicated surgical procedure. As someone once said, vigilance takes on new meaning when describing the anesthetic management techniques of patients undergoing endoscopic laser surgery.

Endotracheal Tube Fires: A Major Cause of Malpractice Suits Incidence Reduced Through Safety Education

Laser Medicine and Surgery News and AdvancesVol. 6, No. 1 Endotracheal Tube Fires: A Major Cause of Malpractice Suits Incidence Reduced Through Safety EducationNorman BaumanNorman BaumanSearch for more papers by this authorPublished Online:20 Sep 2010https://doi.org/10.1089/lms.1988.6.1.1AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Volume 6Issue 1Feb 1988 To cite this article:Norman Bauman.Endotracheal Tube Fires: A Major Cause of Malpractice Suits Incidence Reduced Through Safety Education.Laser Medicine and Surgery News and Advances.Feb 1988.1-3.http://doi.org/10.1089/lms.1988.6.1.1Published in Volume: 6 Issue 1: September 20, 2010PDF download

Endotracheal tube safety during laser surgery

The most morbid complication of laryngeal laser surgery is an endotracheal tube fire. The purposes of this study were to determine the efficiency of saline solution-soaked cottonoid pledgets in protecting endotracheal tube cuffs from the laser beam and to evaluate the safety of four commonly used endotracheal tubes. The method involved measurement of perforation times of saline-soaked cottonoid pledgets with controlled variables of air exposure times and laser energy. The second part evaluated the safety and ignition properties of the red rubber, silicone, polyvinyl chloride, and Xomed Laser-Shield tubes by studying their perforation times and ignition properties under controlled oxygen concentrations. The results revealed that saline-soaked pledgets are very efficient in protecting endotracheal tube cuffs. The Laser-Shield tube was the safest one studied. It had the highest ignition threshold of the four tubes tested.

Flammability of endotracheal tubes in oxygen and nitrous oxide enriched atmosphere.

Endotracheal tube (ETT) fire has been reported secondary to laser and electrocautery ignition. The flammability of polyvinylchloride (PVC), silicone (Si), and red rubber (RR) ETTs in oxygen (O2) and/or nitrous oxide (N2O) in nitrogen was determined and compared by means of the O2 and N2O indices of flammability. The O2 index of flammability is the minimum O2 fraction in nitrogen that will support candle-like flame using a standard ignition source. The O2 index of flammability for PVC ETTs is 0.263, for Si 0.189, and for RR 0.176. The N2O index of flammability is the minimum N2O fraction in N2 that will support candle-like flame using a standard ignition source. The N2O index of flammability for PVC ETTs is 0.456, for Si ETTs 0.414, and for RR ETTs 0.374. The indices are additive. Flammability is a valid method of comparing safety of various endotracheal tube materials. There is a need for new endotracheal tube material with a higher index of flammability. The significance of these findings and the clinical applications are discussed.

Comparison of Tracheal Damage From Laser-Ignited Endotracheal Tube Fires

Studies were undertaken by the Departments of Otolaryngology-Head and Neck Surgery and Anesthesiology at Northwestern University Medical School and the Medical College of Wisconsin (Milwaukee) to compare the potential for tissue injury to the trachea and lungs of canines. Polyvinylchloride (PVC), Rusch red rubber, and silicone tubes were tested. The effects of an intraluminal tube fire on the larynx and trachea were documented with laryngeal and bronchoscopic photographs taken immediately postburn and at the time of sacrifice six hours later. The most severe burns were associated with the PVC tube. Silica ash was seen in the airway after the silicone tube fires and raises the possibility of future problems with silicosis. Histological examination of the trachea showed acute injury in all of the animals; specimens from the dogs with the PVC tube fires demonstrated the most severe cellular damage.