Long-term Survival after Endobronchial Fire during Treatment of Severe Malignant Airway Obstruction: Conclusion

We reviewed the laser record in our case for possible causes of the fire. No differences in pulse frequency or total energy delivered were found by 10-second or 2-minute treatment intervals. We found a maximum of five pulses delivered per any 10-second interval, and only three pulses were delivered at the time of the fire. Thus, we concluded the most likely cause of the fire was the increased FIo2. When complications occur, quick, decisive action is imperative. Our case illustrates that rapid removal of the burning materials can minimize trauma and morbidity. It should also be noted that the potential exists for larger disaster when vigorously burning materials are directly connected to anesthesia equipment and volatile gases.

We agree with the previously reported recommendations for LPT*- and suggest the following additional points:
1. There must be adequate pre- and intraoperative discussion between the laser therapist and anesthesia team to review procedures and safety precautions, with emphasis on the risk factors for fire. All changes in therapy must be reported immediately to all members of the team.
2. During LPT, the FIo2 should not exceed 0.5 and preferably remain less than 0.4. An oximetric device should be employed to continously monitor oxygen saturation. If high FIo2 levels are necessary, use of the rigid bronchoscope may be desirable.
3. At least two functioning laser fibers should be available at any time, and the use of nonsheathed catheters should be discouraged.
4. If an endobronchial fire occurs, the FOB, laser fiber, and ETT should be removed from the patient as quickly as possible. The anesthesia circuit should be separated immediately from the anesthesia machine, and all gas flow turned off to reduce the chance for the fire to spread. The patient should be ventilated by mask with room air until the fire has been extinguished.
5. A fire extinguisher should be available in the room during LPT cases using FOB.

Category: Airway Obstruction

Tags: airway, endobronchial fire, trachea