The Laryngoscope · 2025
Revisiting Fire Safety Guidelines in CO2 Laser Airway Surgery.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Roitman Ariel, Dailey Seth H, Wilson Marcus, Bowen Andrew J, Schroeder Kristopher M, Thibeault Susan L
Аннотация
INTRODUCTION: The potential for airway fire during endoscopic laser surgery is well known, typically addressed by reducing FiO2 levels. This study revisits these established practices in CO2 laser tubeless airway surgery.
MATERIALS AND METHODS: Using a cadaveric porcine larynx and lung model, we conducted trials with high-flow (HFV) and jet ventilation. We varied FiO2 levels and laser power settings to record the onset and number of brief, expansive, and blowtorch flames.
RESULTS: Flames were observed in all jet ventilation trials. Multivariable model results showed that increasing laser wattage decreased onset times for expansive/blowtorch flames and increased their frequency (p < 0.05). Increased FiO2 changes were not significant (p > 0.05). HFV trials revealed no expansive flames at 4 W at 100%, 6 W at 70%, and 10 W at 50% FiO2. Increasing wattage shortened flame onset and increased frequency across all flames (p < 0.01), while increasing FiO2 only reduced onset time for brief flames (p < 0.05). Jet ventilation led to higher flame incidence and shorter onset times than HFV (p < 0.05).
CONCLUSION: Fire risk during CO2 laser surgery in oxygen-rich environments is influenced more by wattage, rather than FiO2 levels. Jet ventilation consistently produced expansive flames, even at lower FiO2 levels and wattage, supporting a FiO2 limit of 30% for this ventilation technique. Our findings support HFV as a potentially safer option for CO2 laser surgery, with safe zones of 4 W at 100%, 6 W at 70%, and 10 W at 50% FiO2, provided laser application is under 30 s. Our model's calculation of excess risk from wattage increments can help surgeons assess this fire risk.
MATERIALS AND METHODS: Using a cadaveric porcine larynx and lung model, we conducted trials with high-flow (HFV) and jet ventilation. We varied FiO2 levels and laser power settings to record the onset and number of brief, expansive, and blowtorch flames.
RESULTS: Flames were observed in all jet ventilation trials. Multivariable model results showed that increasing laser wattage decreased onset times for expansive/blowtorch flames and increased their frequency (p < 0.05). Increased FiO2 changes were not significant (p > 0.05). HFV trials revealed no expansive flames at 4 W at 100%, 6 W at 70%, and 10 W at 50% FiO2. Increasing wattage shortened flame onset and increased frequency across all flames (p < 0.01), while increasing FiO2 only reduced onset time for brief flames (p < 0.05). Jet ventilation led to higher flame incidence and shorter onset times than HFV (p < 0.05).
CONCLUSION: Fire risk during CO2 laser surgery in oxygen-rich environments is influenced more by wattage, rather than FiO2 levels. Jet ventilation consistently produced expansive flames, even at lower FiO2 levels and wattage, supporting a FiO2 limit of 30% for this ventilation technique. Our findings support HFV as a potentially safer option for CO2 laser surgery, with safe zones of 4 W at 100%, 6 W at 70%, and 10 W at 50% FiO2, provided laser application is under 30 s. Our model's calculation of excess risk from wattage increments can help surgeons assess this fire risk.