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Fire safety study on high-flow nasal oxygen in shared-airway surgeries with diathermy and laser: simulation based on a physical model

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Abstract

High-flow nasal oxygen (HFNO) has been used in “tubeless” shared-airway surgeries but whether HFNO increased the fire hazard is yet to be examined. We used a physical model for simulation to explore fire safety through a series of ignition trials. An HFNO device was attached to a 3D-printed nose with nostrils connected to a degutted raw chicken. The HFNO device was set at twenty combinations of different oxygen concentration and gas flow rate. An electrocautery and diode laser were applied separately to a fat cube in the cavity of the chicken. Ten 30 s trials of continuous energy source application were conducted. An additional trial of continuous energy application was conducted if no ignition was observed for all the ten trials. A total of eight short flashes were observed in one hundred electrocautery tests; however, no continuous fire was observed among them. There were thirty-six events of ignition in one hundred trials with laser, twelve of which turned into violent self-sustained fires. The factors found to be related to a significantly increased chance of ignition included laser application, lower gas flow, and higher FiO2. The native tissue and smoke can ignite and turn into violent self-sustained fires under HFNO and continuous laser strikes, even in the absence of combustible materials. The results suggest that airway surgeries must be performed safely with HFNO if only a short intermittent laser is used in low FiO2.

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Acknowledgements

The authors acknowledge the funding supplied by the Taipei Veterans General Hospital. The authors also want to thank the Fire Experiment Center, Architecture and Building Research Institute, Ministry of the Interior, ROC (Taiwan), for technical support.

Funding

This research is sponsored by Taipei Veterans General Hospital, Taiwan, R.O.C. under Project No. V109B-019.

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Author notes

  1. Man-Yun Chang and Jui-Hung Chen are joint co-first authors.

Authors and Affiliations

  1. Department of Anesthesiology, Taipei Veterans General Hospital, No. 201, Shih-Pai Rd. 2nd, Beitou, Taipei City, Taiwan

    Man-Yun Chang, Jui-Hung Chen, Shih-Pin Lin, Wei-Nung Teng, Chien-Kun Ting, Mei-Yung Tsou & Fu-Wei Su

  2. Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan

    Shu-Wei Liao

  3. School of Medicine, National Yang-Ming University, Taipei City, Taiwan

    Chien-Kun Ting & Mei-Yung Tsou

  4. Department of Biomedical Engineering, National Yang-Ming University, Taipei City, Taiwan

    Hui-Hua Kenny Chiang & Fu-Wei Su

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  1. Man-Yun Chang
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Contributions

MYC: This author helped with designing and conducting the experiment, data acquisition, and drafting and revising the manuscript. JHC: This author helped with designing and conducting the experiment, data acquisition, and drafting and revising the manuscript. SPL: This author helped with the statistical analysis and manuscript revision. WNT: This author helped with the statistical analysis and manuscript revision. SWL: This author helped with the statistical analysis and manuscript revision. CKT: This author helped with revising the manuscript. MYT: This author helped with designing the experiment and revising the manuscript. HHKC: This author helped with drafting and revising the manuscript. FWS: This author helped with designing and conducting the experiment, funding acquisition, and drafting and revising the manuscript.

Corresponding author

Correspondence to Fu-Wei Su.

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The authors declare no conflicts of interest related to the subject matter or materials discussed in this article.

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The department of medical research of Taipei Veterans General Hospital has confirmed that no ethical approval is required.

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Chang, MY., Chen, JH., Lin, SP. et al. Fire safety study on high-flow nasal oxygen in shared-airway surgeries with diathermy and laser: simulation based on a physical model. J Clin Monit Comput 36, 649–655 (2022). https://doi.org/10.1007/s10877-021-00690-4

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  • DOI: https://doi.org/10.1007/s10877-021-00690-4

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