Endotracheal tube fires still happen – A short overview

Abstract

Laser generated operating room fires have been reported ever since lasers have been used for therapeutic indications. This occurs because, when an ignition source such as the laser, is used in the vicinity of high oxygen concentrations, and materials, such as the endotracheal tube (ETT), can then be easily ignited. This paper shows examples of ETTs after such a fire, together with the severe injuries incurred. Even though over the years a great deal of experience has been collected in the management and handling of these patients, accidents with ETT fires still occur.

Many different materials have been tested for ETTs with regard to their incendiary characteristics, and special constructions of ETTs for use with lasers have been developed accordingly. Whereas wrapping the ETT with metal foil gives a false sense of safety, the so-called ‘laser-tubes’ exhibit an increased resistance to damage by laser radiation. However, even using these, ETT fires have still occurred due to contamination with blood or because the laser has hit the connection of the cuff with the shaft of the tube. These particular aspects have recently been investigated, and international standards are being prepared, which will hopefully promote the development of proven laser-suited ETTs in an effort to reduce the frequency of these severe accidents.