Crit Care Resusc
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We describe two patients with tracheostomies who showed difficulty in weaning from mechanical ventilation, but were eventually weaned after use of a fenestrated tracheostomy tube with a speaking valve. The first patient underwent mechanical ventilation after pulmonary bleeding, while the second needed ventilator support because of tracheomalacia. Both patients needed only slight ventilator support but developed respiratory distress when it was discontinued. ⋯ The valved tube allowed the first patient to control breath-holding, and the second to avoid tracheal collapse. Regaining vocal cord function improved their pulmonary mechanics, which was demonstrated by dramatic improvement of findings on chest x-ray and computed tomography. A fenestrated tracheostomy tube is usually used to improve daily activities of patients with tracheostomies, but might be worth trying for difficult ventilator weaning.