1 Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Otolaryngol Head Neck Surg. 2018 Apr;158(4):598-616. doi: 10.1177/0194599817746926. Epub 2018 Jan 23.
Objective To bring attention to the epidemiology, prevention, management, and consequences of surgical fires in otolaryngology by reviewing the literature. Data Sources PubMed, EMBASE, Web of Science, and Scopus. Review Methods Comprehensive search terms were developed, and searches were performed from data source inception through August 2016. A total of 4506 articles were identified; 2351 duplicates were removed; and 2155 titles and abstracts were independently reviewed. Reference review was also performed. Eligible manuscripts described surgical fires involving patients undergoing otolaryngologic procedures. Results Seventy-two articles describing 87 otolaryngologic surgical fire cases were identified. These occurred during oral cavity or oropharyngeal procedures (11%), endoscopic laryngotracheal procedures (25%), tracheostomies (36%), "other" general anesthesia procedures (3%), and monitored anesthesia care or local procedures (24%). Oxidizing agents consisted of oxygen alone (n = 63 of 81, 78%), oxygen and nitric oxide (n = 17 of 81, 21%), and room air (n = 1 of 81, 1%). The fractional inspired oxygen delivered was >30% in 97% of surgical fires in non-nitrous oxide general anesthesia cases (n = 35 of 36). Laser-safe tubes were used in only 12% of endoscopic laryngotracheal cases with endotracheal tube descriptions (n = 2 of 17). Eighty-six percent of patients experienced acute complications (n = 76 of 87), including 1 intraoperative death, and 22% of patients (n = 17 of 77) experienced long-term complications. Conclusion Surgical fires in otolaryngology persist despite aggressive multi-institutional efforts to curb their incidence. Guideline recommendations to minimize the concentration of delivered oxygen and use laser-safe tubes when indicated were not observed in many cases. Improved institutional fire safety practices are needed nationally and internationally.
目的 通过回顾文献，引起人们对耳鼻喉科手术火灾的流行病学、预防、处理和后果的重视。
数据来源 PubMed、EMBASE、Web of Science 和 Scopus。
研究方法 制定了全面的检索词，并从各数据源建立起对文献进行了检索，检索时间截至 2016 年 8 月。共识别出 4506 篇文章，排除 2351 篇重复文章，独立审查了 2155 篇标题和摘要。还进行了参考文献回顾。合格的文献描述了涉及接受耳鼻喉科手术患者的手术火灾。
结果 共确定了 72 篇描述 87 例耳鼻喉科手术火灾病例的文章。这些火灾发生在口腔或口咽手术（11%）、内镜喉气管手术（25%）、气管切开术（36%）、“其他”全身麻醉手术（3%）和监测麻醉护理或局部手术（24%）期间。氧化剂包括纯氧（81 例中的 63 例，78%）、氧和一氧化氮（81 例中的 17 例，21%）和室内空气（81 例中的 1 例，1%）。非氧化亚氮全身麻醉手术火灾中，97%（36 例中的 35 例）输送的吸入氧分数超过 30%。在有气管内管描述的内镜喉气管病例中，仅 12%（17 例中的 2 例）使用了激光安全管。86%（87 例中的 76 例）的患者发生急性并发症，包括 1 例术中死亡，22%（77 例中的 17 例）的患者发生长期并发症。
结论 尽管采取了多机构积极措施来遏制其发生率，但耳鼻喉科手术火灾仍持续存在。在许多情况下，并未观察到将输送氧气浓度降至最低并在需要时使用激光安全管的指南建议。需要在国内外改善机构消防安全实践。
