Fire in the Airway

Introduction
 An airway fire is a fire that occurs within a patient’s
airway or in airway device or contiguous breathing
circuit.
 Rare but catastrophic outcomes

 Most preventable with communication, appropriate

education and management of risks.
 Aetiology
 Airway fire classical triad
 1. Ignition source
 2. An oxidixer
 3. A fuel sources
Ignition sources
 Ignition Sources
 Electrosurgery Unit –
 High temperature electrical arc
 Can be ignited by either monopolar tip, or loose or worn connectors and cables.

 Surgical lasers
 High power lasers can ignite any dry materials they contact
 Lasers that are broken or cracked result in escape of energy to nearby
flammable materials.

 Fiberoptic Lights
 Create very high temperatures if focused ona specific spot
 If not connected to an output device they can burna patient directly, or ignite or
melt surgical drapes.

 Other potential sources

 Oxidizer
 Oxygen and nitrous oxide

 Can accelerate the burning process.

 Oxygen
 95% of fires
 Open delivery through a nasal cannula or face mask
 At concentrations near 50% any spark or generated heat can ignite a
fuel source
 During laproscopy, gas line connection areas resulting in O2
insulffation of abdomen can cause intra-abdominal fires

 Nitrous Oxide
 Same oxidizing potential as oxygen
 Fuel Source
 Fuel source table
 Fuels
 Alcohol-based prep solutions
 70 to 75% isopropyl alcohol
 Should be allowed to dry at least 3 mins before use of an
ignition source
 Povidone-iodine and chlorhexidine solutions are not
flammable and do not require a set drying time before use of
an ignition source

 Surgical Drapes, towels, sponges, gauzes

 When oxygen levels >50% become trapped in the fine fibers
and naps of cotton towels or drapes.
 “Fiber flame propagation”
 Fuels
 Endotracheal tubes, laryngeal masks
 Made of silicone or polyvinyl chloride readily burn

 Organic Matter
 Hair can ignite especially If coated with wet alcohol
 Fine body hair can result in fiber flame propagation
 Bowel gas can ignite due to its composition of
methane, hydorgena nd oxygen.
 Mannitol-based boel preps produce more gas than
polyethelne or sodium sulfate preps.
 Risk Based Approach to
Fire prevention
 Key elements to risk pervention are:
 Risk assessment
 Communication among members of the surgical team
 Preventative measures based on level of risk