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Maintained expiratory airway pressure values as an indicator of tolerance of speaking valve in tracheostomized patients Introduction: Speaking valve (SV) is an unidirectional fl ow device installed over the tracheostomy tube allowing phonation. Tolerance to this device depends on the permeability of the upper airway (UA), which may be indirectly assessed by measuring UA maintained expiratory pressure (PEMant). Objective: To evaluate the usefulness of the maintained expiratory pressure as a clinical indicator of tolerance to the SV. Method: Twenty three tracheostomized patients (median age 22 months-old) were evaluated with an aneroid manometer during 15 minutes, recording PEMant, arterial oxygen saturation (SaO 2), heart rate, respiratory rate, accessory muscle use and wheezing as signs of respiratory distress Results: PEMant values less than 10 cmH 2 O are associated with tolerance of the SV and values over 20 cmH 2 O are associated with intolerance. Conclusion: Values under 10 cmH 2 O of PEMant can be used as an indicator of tolerance to VF.