Severe risk of aspiration Severe Chronic Obstructive Pulmonary Disease Endotracheal tubes During sleep Severe non-compliant lungs. Patients recovering room a reversible restrictive lung disease may be able to tolerate the talking valve for short periods of time with close monitoring. Do not leave the speaking valve in place during administration of nebulized medications as this may cause the valve to stick closed. The patient should be able to move air freely around the tracheostomy tube both during inhalation and exhalation. Assess for risk of aspiration of secretions.
Cuff deflation is contraindicated in patients aspirating secretions.
Consider contacting the physician regarding a speech consult for the following indications. Tracheal suction the patient if needed. Deflate the tracheostomy tube cuff if applicable. The patient will begin to cough due to the directional change of airflow. Suction if the cough sounds wet.