Airway Fire

 

 

Management

 

  • Inform team & call for help

  • Simultaneously remove the endotracheal tube (ETT) & stop gases/disconnect circuit

  • Pour saline or water into airway

  • Remove airway foreign bodies (ie: ETT pieces, sponges)

  • When fire is extinguished: re-establish ventilation; avoid supplemental oxygen if possible

  • Consider prompt reintubation prior to swelling & coordinated with bronchoscopy

  • Examine entire airway (including bronchoscopy) to assess injury & remove residual debris

 

 

Prevention

 

  • For high risk procedures:

    • Discuss fire prevention & management with team during time-out

    • Avoid FiO2 > 0.3 & avoid N2O

  • For laser surgery of vocal cord or larynx:

    • Use laser resistant ETT (single or double cuff)

    • Assure ETT cuff sufficiently deep below vocal cords

    • Fill proximal ETT cuff with methylene blue-tinted saline (acts as a marker if cuff perforated by laser)

    • Ensure laser in STANDBY when not in active use

    • Surgeon protects ETT cuff with wet gauze

    • Surgeon confirms FiO2 < 0.3 & no N2O prior to laser use (may require several minutes to dilute FiO2 & FeO2 to <0.3 depending on fresh gas flow & initial FiO2)

  • For non-laser surgery in oropharynx:

    • Regular PVC ETT may be used

    • Consider packing wet gauze around ETT to minimize O2 leakage

    • Consider continuous suctioning of the operating field inside oropharynx