The importance of lubrication
The use of lubrication gel is commonly applied to endotracheal tube to
both help facilitate the passage of the tube through the glottal opening
and to aid with the formation of a seal around the endotracheal tube
cuff and the tracheal wall (Nishioka, Usuda, Hirabayashi, Maruyama, &
Andoh, 2017). The instillation of lubrication gel has also been
instilled to help remove endotracheal tubes that were stuck in the
trachea (Romano & Portela, 2020) as was the case in this report.
Lubrication gel also helps minimize the risk of the endotracheal tube
‘sticking’ to the tracheal mucosa. I have observed this during my
clinical practice, especially with nasotracheal tube placement. In this
case, the authors speculate that the tight fit of the endotracheal tube
resulting in oedema formation at the location of the cuff. Dorsal
recumbency would have contributed to this risk due to the increase in
hydrostatic pressures (Binetti et al., 2018). Once these changes occur,
it can very difficult to remove an endotracheal tube as evident by the
efforts of the authors of this case study and other techniques used to
help minimize this tracheal swelling, including the instillation of
adrenaline (Grzywa & Barker, 2022). It is interesting to note that the
use of benzodiazepines and neuromuscular blockers (Grzywa & Barker,
2022) have also failed to induce tracheal relaxation in other reported
clinical situations.