Elevated Oxygen Level Causes Fatal Surgical Fire

This case involves a 78-year-old male patient with a history of COPD who developed pneumonia and required intubation. Because the patient was difficult to wean, the attending physician ordered a tracheostomy. During the procedure, there was an electrocautery-ignited surgical field fire caused by high oxygen levels. As a result, the tube melted and severely burned the patient. He eventually went into respiratory distress and expired as a result of the electrocautery accident.

Question(s) For Expert Witness

1. Please describe your background in anesthesiology.

2. How is the level of oxygen controlled during a tracheostomy?

Expert Witness Response E-185787

I currently work at a teaching hospital, and frequently discuss safety measures during tracheostomy and airway fire prevention as part of our residency and medical student training program. During tracheostomy placement, the inspiratory oxygen level should be maintained at the lowest level that is safe for that patient and does not cause arterial desaturation. This is done to reduce the risk of airway fires such as the one that occurred in this case. For patients with healthy lungs who are undergoing tracheostomy prior to resection of head and neck cancers, the safe inspiratory oxygen level may be as low as 25%. For critically ill patients or ventilator-dependent patients, the safe inspiratory oxygen level may be much higher. Communication between the surgical and anesthesia teams is critically important during tracheostomy placement. When a high inspiratory oxygen level is necessary, the surgeons may need to alter their techniques and avoid ignition sources such as electrocautery.