A patient's ability to communicate is critical to overall medical care, psychological functioning, and social interactions. Voice intensity levels produced by 20 patients with Portex "Talk" cuffed speaking tracheostomy tubes were investigated at three different airflow rates. Results indicated that audible and intelligible speech was produced with significantly greater intensity (P less than .001) over ambient room noise at 5 l/minute, 10 l/minute, and 15 l/minute of airflow. Also, significantly greater voice intensity (P less than .001) was noted as airflow increased from 5 l/minute to 10 l/minute and from 10 l/minute to 15 l/minute. The criteria, rationale, and importance of using a speaking tracheostomy tube with cognitively intact ventilator-dependent patients are discussed. The specific advantages and disadvantages of the Portex "Talk" tracheostomy tube are delineated. A case study is included.