Al Strachen is a 16-year-old patient with quadriplegia and a C7 fracture caused by a diving accident. He is currently in a rehabilitation facility. He has a size 6 nonfenestrated cuffed tracheostomy tube in place. The physiatrist has requested that the nurse provide a tracheostomy adjunct to allow the patient to speak. The nurse obtained a Passy-Muir valve and attached it to the 15-mm adapter of the inner cannula. You were then called STAT to evaluate the patient for severe respiratory distress. Explain why the patient did not tolerate the procedure and what you would need to do to correct the situation.

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