The Passy-Muir Valve (PMV) is the standard of care for our pediatric and adult ventilator and tracheostomy tube patients. Passy-Muir, Inc. is committed in their efforts to offer these patients a step toward independence and dignity through speech, and has designated Madonna the first of just twelve Centers of Excellence in the country. The PMV has a one-way valve that connects to the tracheostomy tube. Air is inhaled through the trach tube, and exhaled through the mouth. The valve opens during inspiration to allow air to go into the lungs. The valve closes during expiration and directs air up through the vocal cords to allow speech. The use of the PMV by our transdisciplinary team has contributed significantly to the success of our ventilator and trach tube weaning outcomes.