Endotracheal tube removal requires ability to protect airway

Is a gag reflex present?

Can the patient cough?  (Consider using a "white card" test.  Disconnect the patient from the ventilator, place a white index card in front of the patient, and if they can hock a loogie onto the card, they have an adequate cough)

Are the patients secretions managable?

Can they protect the airway?  (They do NOT need to be completely alert to do this)