Anesthesia & Analgesia

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Anesthesia & Analgesia:
doi: 10.1213/ANE.0b013e318298a692
Patient Safety: Research Report

Prevention of Airway Fires: Do Not Overlook the Expired Oxygen Concentration

Remz, Matthew; Luria, Isaac BS; Gravenstein, Michael; Rice, Scott D.; Morey, Timothy E. MD; Gravenstein, Nikolaus; Rice, Mark J. MD

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BACKGROUND: It is generally accepted that when an ignition source is used the inspired oxygen concentration (FIO2) should be <30% in the breathing circuit to help prevent airway fires. The time and conditions required to reduce a high O2% in the breathing circuit to <30% has not yet been systematically studied.

METHODS: We evaluated the inspired and expired circuit oxygen concentration response times of an Aestiva Avance S/5 anesthesia machine to reach an FIO2 of <30% from a starting FIO2 of 100% and 60% after reducing the FIO2 to 21%. The circuit was connected to a human patient simulator which has a functional residual capacity of 2 L, total lung capacity of 2.8 L, an oxygen consumption of 200 mL/min, and respiratory quotient of 0.8. Fresh gas flow (FGF) inputs of 2 L/min and 5 L/min were chosen to represent a spectrum of typical clinical FGF rates. Minute ventilation was set at 4 L/min. Determining the requisite median time to reach an O2 concentration of <30% in the breathing circuit was the primary aim of the study.

RESULTS: The median times (1st–99th percent confidence interval) required to achieve inspiratory and expiratory oxygen concentrations of <30% with the extended circuit configuration when starting at 60% for 5 L FGFs were 35 (32–36) and 104 (88–122) seconds, respectively. With 2 L FGF, these median times increased to 303 (291–313) and 255 (232–278) seconds, respectively. A shortened circuit configuration (P = 0.006) and higher FGF flow rate (P < 0.0001) were noted to be factors decreasing the median time required to achieve an oxygen concentration of <30%.

CONCLUSIONS: Both inspired and expired circuit oxygen concentration may take minutes to decrease to <30% depending on circuit length, FGF rate, and starting circuit oxygen concentration. During the reduction in FIO2, the expiratory oxygen concentration may be >30% for a considerable time after the FIO2 is in a “safe” range. An increased expired oxygen concentration should also be considered an airway fire risk, and patient care protocols may need to be modified based on future studies.

© 2013 International Anesthesia Research Society


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