• Man-Yun Chang, Jui-Hung Chen, Shih-Pin Lin, Wei-Nung Teng, Shu-Wei Liao, Chien-Kun Ting, Mei-Yung Tsou, Hui-Hua Kenny Chiang, and Fu-Wei Su.
• Department of Anesthesiology, Taipei Veterans General Hospital, No. 201, Shih-Pai Rd. 2nd, Beitou, Taipei City, Taiwan.
• J Clin Monit Comput. 2022 Jun 1; 36 (3): 649-655.

AbstractHigh-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.© 2021. The Author(s), under exclusive licence to Springer Nature B.V.

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