Ultra-slippery, nonirritating, and anti-inflammatory hyaluronic acid-based coating to mitigate intubation injury

Endotracheal intubation is a crucial procedure for mechanical ventilation and respiratory support therapy. However, friction mismatch between the tube material and tissues often causes complications, such as laryngopharyngeal airway mucosa injury, tracheal granuloma, and inflammatory reaction. In this work, a highly lubricated coating was designed and applied on the tracheal tube. Hyaluronic acid (HA) and triblock copolymer (Pluronic F127) were co-deposited on the surface-activated tube to form a hydration layer through intermolecular interaction. The coating exhibited high artificial saliva adsorption ratio and water-retention rate, providing excellent lubrication to the tube. The friction coefficient of the coated tube in artificial saliva was 77% less than that observed for the original tube. The efficacy of the lubricated coating on endotracheal intubation was assessed in vivo by using a cynomolgus monkey model. The coating was demonstrated to be effective to alleviate the injury caused by endotracheal intubation.