氣管切開手術中因使用電燒引發氣管內管著火燃燒之病例報告

Endotracheal Tube Fire Induced by Electrocautery during Tracheostomy-- A Case Report

氣管切開手術中因使用電燒引發氣管內管著火燃燒是一種很嚴重且可能致命的併發症。所以，應該要避免發生，而且一旦發生就得快速反應處理。這位88歲男性因呼吸衰竭，且預期可能會長期依賴呼吸器支持而接受常規氣管切開手術。不幸地在以電燒在氣管切開附近止血時，突然有火花由氣管切開附近冒出。經過緊急滅火及支氣管內視鏡檢查後，氣切內管仍順利地置入。病患在過程中並沒有嚴重血氧下降及血壓不穩的情況發生，所以，病患在加護病房觀察兩星期並給予一般呼吸治療後，順利的由加護病房轉到普通病房，並沒有發生其他相關併發症。因此，由此病例我們強調在氣管切開手術中使用電燒的情況下，除了一般注意應調降吸入的氧氣濃度及小心使用電燒外，我們也應重視氣管內管氣囊，因為它可預防當氣管內管尚未拔除前氧氣外漏，而讓電燒使用過程引燃了氣管內管。

Airway fire resulting from ignition of the endotracheal tube (ETT) caused by electrocautery during tracheostomy is a severe and possibly fatal event, and should be avoided. An 88-year-old male because of respiratory failure received elective tracheostomy for ventilatory support on which prolonged dependence was anticipated. Unfortunately, flame was noted to jet out from the trachea incision just after a single burst of electrocautery to coagulate a bleeder in the trachea tissue nearby the incision. After primary management, including extinguishing the flame and evaluation of the tracheal injury by bronchoscope, a tracheostomy tube was inserted smoothly without causing hypoxemia or hemodynamic instability. The patient stood this ordeal of fire well without related sequelae and was returned from the intensive care unit (ICU) to the general ward two weeks later. From this accident, we recommend that, besides emphasis on lowering of the inspired oxygen concentration (FiO2) and careful use of electrocautery during the tracheostomy procedure, special attention should be paid to the integrality of ETT cuff. It serves as a barrier to prevent oxygen leaking out from the trachea to be exposed to the sparks of electrocautery while the surgical procedure is under way, and thus it plays a significant role in the avoidance of airway fire induced by electrocautery.