The patient was hospitalized with a one-week history of flu- like symptoms. His deteriorating respiratory status required tracheal intubation and mechanical ventilation at first, and then a tracheostomy on the seventh day of hospitalization. Electrocautery in the cutting mode was used to dissect to the trachea and to create the tracheostomy. It was kept in operation at the stomal site during the brief period of exposure to 100 percent oxygen. During removal of the endotracheal tube (ETT), which brought the oxygen stream past the stroma and the electrocautery, the ETT ignited and the patient sustained burns to the airways. This together with the inhalation of potentially toxic fumes may have caused progression of his underlying bacterial and fungal infection and the development of diffuse alveolar damages. Death occurred 13 days after the tracheostomy. The electrocautery provided the source of ignition, oxygen served as the oxidant, and the polyvinyl chloride ETT became the fuel. To reduce the risk of fire during ETT, less flammable tubes; moist, occlusive pharyngeal packs; use of nitrogen, helium or carbon dioxide as anesthetic oxidizing agents; and use of bipolar cautery are advised. 4 figures and 11 references (Author abstract modified)