Airway fire during awake tracheostomy using high-flow nasal oxygen

Area of Science:

• Anesthesiology
• Surgical Safety
• Respiratory Care

Background:

• High-flow nasal oxygen (HFNO) is widely adopted for complex head and neck surgeries and managing difficult airways.
• Patient obesity and supraglottitis presented an extreme airway challenge, necessitating an awake tracheostomy.

Observation:

• An operating room fire ignited during the procedure, shortly after the operation commenced and before tracheal incision.
• The fire was initiated by electrical diathermy applied to subcutaneous vessels, igniting a small flame.
• The fire was rapidly extinguished without patient harm, and the tracheostomy was successfully completed.

Findings:

• The fire triad (fuel, heat, oxidizer) was present: high-flow oxygen acted as the oxidizer, subcutaneous tissue or vaporized fat served as fuel, and diathermy provided the ignition source.
• Oxygen, channeled under surgical drapes, likely contributed to the fire's propagation.

Implications:

• Healthcare providers must be vigilant about the risk of operating room fires when using concentrated oxygen, particularly HFNO.
• Minimizing oxygen accumulation under drapes and controlling potential ignition sources are crucial for preventing such incidents.
• Awareness and proactive management of fire risk factors are essential throughout all stages of procedures involving high-flow oxygen therapy.