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Day AT, Rivera E, Farlow JL, Gourin CG, Nussenbaum B. Surgical Fires in Otolaryngology: A Systematic and Narrative Review. Otolaryngol Head Neck Surg 2018; 158:598-616. [DOI: 10.1177/0194599817746926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To bring attention to the epidemiology, prevention, management, and consequences of surgical fires in otolaryngology by reviewing the literature. Data Sources PubMed, EMBASE, Web of Science, and Scopus. Review Methods Comprehensive search terms were developed, and searches were performed from data source inception through August 2016. A total of 4506 articles were identified; 2351 duplicates were removed; and 2155 titles and abstracts were independently reviewed. Reference review was also performed. Eligible manuscripts described surgical fires involving patients undergoing otolaryngologic procedures. Results Seventy-two articles describing 87 otolaryngologic surgical fire cases were identified. These occurred during oral cavity or oropharyngeal procedures (11%), endoscopic laryngotracheal procedures (25%), tracheostomies (36%), “other” general anesthesia procedures (3%), and monitored anesthesia care or local procedures (24%). Oxidizing agents consisted of oxygen alone (n = 63 of 81, 78%), oxygen and nitric oxide (n = 17 of 81, 21%), and room air (n = 1 of 81, 1%). The fractional inspired oxygen delivered was >30% in 97% of surgical fires in non–nitrous oxide general anesthesia cases (n = 35 of 36). Laser-safe tubes were used in only 12% of endoscopic laryngotracheal cases with endotracheal tube descriptions (n = 2 of 17). Eighty-six percent of patients experienced acute complications (n = 76 of 87), including 1 intraoperative death, and 22% of patients (n = 17 of 77) experienced long-term complications. Conclusion Surgical fires in otolaryngology persist despite aggressive multi-institutional efforts to curb their incidence. Guideline recommendations to minimize the concentration of delivered oxygen and use laser-safe tubes when indicated were not observed in many cases. Improved institutional fire safety practices are needed nationally and internationally.
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Affiliation(s)
- Andrew T. Day
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Erika Rivera
- Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Janice L. Farlow
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christine G. Gourin
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Brian Nussenbaum
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Washington University in Saint Louis, Saint Louis, Missouri, USA
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Smędra A, Meissner E, Barzdo M, Grabowski P, Kartasiński M, Krajewski W, Berent J. Iatrogenic Burns of the Neckline in a Patient with Tetraparesis During Tracheotomy. J Forensic Sci 2016; 62:250-253. [PMID: 27861870 DOI: 10.1111/1556-4029.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 05/02/2015] [Accepted: 05/24/2015] [Indexed: 11/30/2022]
Abstract
The paper presents a case of an atypical iatrogenic complication after tracheotomy analyzed on the basis of the case dossier materials submitted to the authors by the court of justice to prepare a forensic medical opinion concerning the correctness of the medical procedure. A 37-year-old woman was brought by the ambulance service to the hospital with acute respiratory failure due to post-tracheostomy tracheal stenosis. Tracheotomy was performed on an emergency basis. The patient suffered severe burns of the chest and neck. The experts concluded that the most probable cause of the incident was electrocautery-induced ignition of the disinfectant used for cleaning the skin before the surgery. It was established that with correct handling of the procedure, the aforementioned incident should not have taken place. Therefore, it cannot be regarded as a normal complication inherent in the risk associated with the procedure, but as a consequence of a medical error.
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Affiliation(s)
- Anna Smędra
- Department of Forensic Medicine, Medical University of Lodz, Sedziowska 18a, Lodz, 91-304, Poland
| | - Ewa Meissner
- Department of Forensic Medicine, Medical University of Lodz, Sedziowska 18a, Lodz, 91-304, Poland
| | - Maciej Barzdo
- Department of Forensic Medicine, Medical University of Lodz, Sedziowska 18a, Lodz, 91-304, Poland
| | - Przemysław Grabowski
- Department of Forensic Medicine, Medical University of Lodz, Sedziowska 18a, Lodz, 91-304, Poland
| | - Michał Kartasiński
- Department of Forensic Medicine, Medical University of Lodz, Sedziowska 18a, Lodz, 91-304, Poland
| | - Wojciech Krajewski
- Intensive Care Unit of Mother Memorial Hospital Research Institute in Lodz, Rzgowska 281/289, Lodz, 93-338, Poland
| | - Jarosław Berent
- Department of Forensic Medicine, Medical University of Lodz, Sedziowska 18a, Lodz, 91-304, Poland
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Gorphe P, Sarfati B, Janot F, Bourgain JL, Motamed C, Blot F, Temam S. Airway fire during tracheostomy. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:197-9. [PMID: 24703002 DOI: 10.1016/j.anorl.2013.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/17/2013] [Accepted: 07/16/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Twenty-five cases of airway fire during tracheostomy have been reported in the literature. The authors describe a case observed in their centre 3 years ago, discuss the causes and preventive management and propose guidelines for prevention of this complication. CASE REPORT A 66-year-old woman was intubated and ventilated with 100% oxygen during general anaesthesia for tracheostomy. On opening the trachea by monopolar diathermy, the oxygen present in the endotracheal tube caught fire, inducing combustion of the tube spreading to the lower airways. This airway fire was responsible for severe acute respiratory failure and the formation of multiple laryngotracheal stenoses. DISCUSSION Combustion of the endotracheal tube due to ignition of anaesthetic gases induced by the heat generated by diathermy is responsible for airway fire. These various phenomena are discussed. Prevention is based on safety measures and coordination of surgical and anaesthetic teams.
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Affiliation(s)
- P Gorphe
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - B Sarfati
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - F Janot
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - J L Bourgain
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - C Motamed
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - F Blot
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - S Temam
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
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Shin YD, Lim SW, Bae JH, Yim KH, Sim JH, Kwon EJ. Wire-reinforced endotracheal tube fire during tracheostomy -A case report-. Korean J Anesthesiol 2012; 63:157-60. [PMID: 22949984 PMCID: PMC3427809 DOI: 10.4097/kjae.2012.63.2.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 08/24/2011] [Accepted: 09/19/2011] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Young Duck Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
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Yardley I, Donaldson L. Surgical fires, a clear and present danger. Surgeon 2010; 8:87-92. [DOI: 10.1016/j.surge.2010.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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Ho AMH, Wan S, Karmakar MK. Flooding With Carbon Dioxide Prevents Airway Fire Induced by Diathermy During Open Tracheostomy. ACTA ACUST UNITED AC 2007; 63:228-31. [PMID: 17622897 DOI: 10.1097/ta.0b013e31805f7011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Open tracheostomy is commonly performed during head and neck surgery, and in critically ill patients. Diathermy-induced airway fire during tracheotomy is rare but may have grave implications. Recommendations to minimize this risk are not always practical. We hypothesized that flooding the surgical field with carbon dioxide is an effective technique in preventing fire. METHODS We cut through the trachea of two pigs using diathermy while ventilating with pure oxygen five times with, and five times without, simultaneous flushing of the surgical field with carbon dioxide at 10 L/min. To increase the amount of oxygen in the airway and the likelihood of fire,we deliberately deflated the endotracheal cuff to simulate cuff rupture. RESULTS Five times out of five, fire was induced when the diathermy cut through the tracheal wall with no carbon dioxide being used. Five times out of five, fire was not induced when carbon dioxide was used. The difference was significant (p < 0.008). CONCLUSIONS Flooding the surgical site with carbon dioxide effectively prevents fire during open tracheostomy using diathermy.
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Affiliation(s)
- Anthony M-H Ho
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR.
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