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Background: Open tracheostomy is commonly performed during head and neck surgery, and in critically ill patients. Diathermy-induced airway fire during tracheotomy is rare but may have grave implications. Recommendations to minimize this risk are not always practical. We hypothesized that flooding the surgical field with carbon dioxide is an effective technique in preventing fire., Methods: We cut through the trachea of two pigs using diathermy while ventilating with pure oxygen five times with, and five times without, simultaneous flushing of the surgical field with carbon dioxide at 10 L/min. To increase the amount of oxygen in the airway and the likelihood of fire,we deliberately deflated the endotracheal cuff to simulate cuff rupture., Results: Five times out of five, fire was induced when the diathermy cut through the tracheal wall with no carbon dioxide being used. Five times out of five, fire was not induced when carbon dioxide was used. The difference was significant (p < 0.008)., Conclusions: Flooding the surgical site with carbon dioxide effectively prevents fire during open tracheostomy using diathermy.

Tracheal intubation during trauma resuscitation is almost always performed with a standard endotracheal tube. Difficulties may arise if lung isolation is required later. The options for achieving lung isolation in seriously traumatized patients are briefly reviewed. Two efficient and airtight systems to allow the insertion of a bronchial blocker with minimal risks are presented.

The authors describe an approach and a novel technique to solve a leaky endotracheal tube cuff problem in ventilator-dependent patients without immediately resorting to the potentially hazardous task of changing an endotracheal tube.