Endotracheal tube fire induced by electrocautery during tracheostomy--a case report

Airway fire resulting from ignition of the endotracheal tube (ETT) caused by electrocautery during tracheostomy is a severe and possibly fatal event, and should be avoided. An 88-year-old male because of respiratory failure received elective tracheostomy for ventilatory support on which prolonged dependence was anticipated. Unfortunately, flame was noted to jet out from the trachea incision just after a single burst of electrocautery to coagulate a bleeder in the trachea tissue nearby the incision. After primary management, including extinguishing the flame and evaluation of the tracheal injury by bronchoscope, a tracheostomy tube was inserted smoothly without causing hypoxemia or hemodynamic instability. The patient stood this ordeal of fire well without related sequelae and was returned from the intensive care unit (ICU) to the general ward two weeks later. From this accident, we recommend that, besides emphasis on lowering of the inspired oxygen concentration (FiO2) and careful use of electrocautery during the tracheostomy procedure, special attention should be paid to the integrality of ETT cuff. It serves as a barrier to prevent oxygen leaking out from the trachea to be exposed to the sparks of electrocautery while the surgical procedure is under way, and thus it plays a significant role in the avoidance of airway fire induced by electrocautery.