title: Flooding with carbon dioxide prevents airway fire induced by diathermy during open tracheostomy.
abstract: 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.
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR. hoamh@hotmail.com
authors.forename: Anthony M-H
authors.initials: AM
authors.lastname: Ho
authors.forename: Song
authors.initials: S
authors.lastname: Wan
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Karmakar
mesh_terms: D000818:Animals; D002245:Carbon Dioxide; D004564:Electrocoagulation / Q000009:adverse effects*; D005390:Fires / Q000517:prevention & control*; D013552:Swine; D014139:Tracheostomy / Q000379:methods*
chemical_list: D002245:Carbon Dioxide