Some speaking valves such as the Passy-Muir Valve and the Montgomery Valve can be used in-line with mechanical ventilation. An overarching theme for patients with tracheostomy in the ICU is that they wanted “to be seen and heard as a whole person.” Patients wanted to be treated as human, and having a voice made a difference (Newman, H., et al, 2022). This handout provides the clinician with some assessment criteria for in-line speaking valve use with mechanical ventilation. A physician order is always necessary prior to speaking valve use (ALWAYS DEFLATE THE CUFF!). Any clinician using a speaking valve should be competent in doing so.