It may be difficult for some hospitals to make a case for the use of these tubes because they are significantly more expensive ($45-60 per tube) than the conventional type (frequently sold for 30 cm H 2O, they could produce ischemic changes in the patient’s tracheal mucosa. The thinner materials are said to seal more effectively and protect against aspiration of supraglottic secretions. ![]() ![]() Cuffs made from polyurethane are approximately seven microns thick while the diameter of a traditional cuff varies from 50 to 80 microns. Newer tubes may have either a barrel or teardrop shape and could be made of polyurethane. Older ET tube cuffs had an elliptical shape and were made of polyvinyl chloride. Research now suggests that the shape and the materials used to construct ET tube cuffs play a part in protecting the patient’s airway against aspiration and ventilator-associated pneumonia. The effectiveness of the endotracheal tube (ET) cuff as a protective feature has been the object of study in the past few years. Patients who have secretions pooling in the back of their mouths demonstrate some degree of swallowing dysfunction and may be at much greater risk for aspiration than those who do not have a gag reflex. It requires the coordination of 26 muscles, five cranial nerves, and input from multiple levels of the central nervous system (brainstem, cerebral cortex).Ĭlearly, this process requires a much higher level of neurological function and thus is a better indicator of the patient’s ability to protect their airway. The swallowing process, however, is much more complex. The stimulus for this is relayed by the ninth and tenth cranial nerves. When a patient gags, the muscles of their soft palate and pharynx contract collectively but briefly. 4Ī second airway assessment strategy would be to evaluate the patient’s ability to swallow. A score of 8 or less and an absent gag reflex could be used as an indication for intubation, 3 but this recommendation is not always followed. Developed in the early 1970s, it is used as a means for evaluating a patient’s neurological status. Is it really a good idea to test the gag reflex of a patient who is secured in a supine position and may have a full stomach? If the reflex is intact, they could easily aspirate and now present with an additional problem.Īn alternative strategy for relying solely on the gag reflex would be to incorporate the use of the Glasgow Coma Scale (GCS) into the assessment process. ![]() One additional point to consider relates to the possible consequences of testing for a gag reflex. Also, work from several sources has shown that as many as 37% of healthy adults have no gag reflex. First, vocal cord paralysis or depression of the gag reflex by sedatives may keep the glottis from completely closing when the gag is induced. ![]() Testing for gag reflex is also part of the American Academy of Neurology’s criteria for determining brain death.Ī number of textbooks recommend testing for gag reflex to determine if a patient should be intubated, but its effectiveness in this case is debatable for at least two reasons. Its absence or presence is used as a guide to determine if either an oral or nasopharyngeal airway should be placed during CPR. The gag reflex is one of the body’s airway protective mechanisms and is easily and commonly tested.
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