CO2 Laser-induced Endotracheal Fire

The objective of this paper is to describe long-term complications and their management in contrast to acute measures after endotracheal laser-induced fire. This case pertains to a 56-year-old patient in whom an endotracheal fire occurred during CO2 laser surgery. Despite local swelling and evidence of acute lung injury, the patient was extubated the following day under single-shot cortisone and inhalation of dispersed adrenaline under assisted spontaneous breathing. Regular flexible bronchoscopy and spirometry were used to assess wound healing. But 14 weeks after uneventful recovery, the patient presented with an acute inspiratory stridor, related to a tracheal stenosis 2.5 cm distal to the glottic level. Further follow-up was uneventful after the detection of tracheal end-to-end anastomosis. Early extubation under ITU conditions avoided the need for tracheostomy and its sequelae. However, tracheal stenosis did not become apparent before week 14. While a conservative approach was successfully implemented in the acute management of laser-induced endotracheal fire, the risk of further long-term complications implies the need for a prolonged follow-up regime even in cases of less extensive burns.