title: Prevention of airway fires: testing the safety of endotracheal tubes and surgical devices in a mechanical model.
abstract: OBJECTIVE
  This study was designed to assess the ability of carbon dioxide (CO2) lasers and radiofrequency ablation devices (Coblator) (ArthoCare Corporation, Sunnyvale, CA) to ignite either a non-reinforced (polyvinylchloride) endotracheal tube (ETT) or an aluminum and fluoroplastic wrapped silicon ("laser safe") ETT at varying titrations of oxygen in a mechanical model of airway surgery.
  
  
  METHODS
  Non-reinforced and laser safe ETTs were suspended in a mechanical model imitating endoscopic airway surgery. A CO2 laser set at 5-30 watts was fired at the ETT at oxygen concentrations ranging from 21% to 88%. The process was repeated using a radiofrequency ablation (RFA) device. All trials were repeated to ensure accuracy.
  
  
  RESULTS
  The CO2 laser ignited a fire when contacting a non-reinforced ETT in under 2 seconds at oxygen concentrations as low as 44%. The CO2 laser could not ignite a laser safe ETT under any conditions, unless it struck the non-reinforced distal tip of the ETT. With the RFA, a fire could not be ignited with either reinforced or non-reinforced ETTs.
  
  
  CONCLUSIONS
  RFA presents no risk of ignition in simulated airway surgery. CO2 lasers should be utilized with a reinforced ETT or no ETT, as fires can easily ignite when lasers strike a non-reinforced ETT. Decreasing the fraction of inspired oxygen reduces the risk of fire.
authors.affiliation: Pediatric Otolaryngology, Children's Memorial Hermann Hospital, Associate Professor of Otolaryngology, University of Texas-Houston School of Medicine, Houston, TX, USA.
authors.forename: Soham
authors.initials: S
authors.lastname: Roy
authors.affiliation: Pediatric Otolaryngology, Steven and Alexandra Cohen Children's Medical Center, Assistant Professor of Otolaryngology, Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, USA.
authors.forename: Lee P
authors.initials: LP
authors.lastname: Smith
mesh_terms: D000535:Aluminum; D017115:Catheter Ablation / Q000295:instrumentation*; D005390:Fires / Q000517:prevention & control*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D054020:Lasers, Gas; D008422:Materials Testing; D010100:Oxygen; D011138:Polytetrafluoroethylene; D011143:Polyvinyl Chloride; D011846:Radio Waves; D012825:Silicon
chemical_list: D011138:Polytetrafluoroethylene; D011143:Polyvinyl Chloride; D000535:Aluminum; D010100:Oxygen; D012825:Silicon