A guide for families
How to communicate with an intubated or tracheostomy patient
Your loved one is awake, hears you and understands you, but can't talk. This is common in the ICU, the intensive care unit, and with a tracheostomy. Not being able to say what they feel often causes distress, for them and for the family. This guide explains why the voice is lost and what ways to communicate exist. Everything is decided and adjusted with the healthcare team.
Why they can't talk
Voice is made when air leaves the lungs and makes the vocal cords vibrate.
When a person is intubated, the breathing tube passes between the vocal cords. That's why they can't talk while it's in place.
With a tracheostomy, air goes in and out through a tube in the neck, below the vocal cords. The air doesn't pass through them, so there is no voice. Many of these tubes have an inflated balloon called a cuff. While it is inflated, the person can't talk.
Having no voice doesn't mean they don't understand. Talk to them normally.
How the patient feels, and why communicating matters
Many patients say it's very hard to make themselves understood. Not being able to talk can cause frustration, anxiety or sadness, and sometimes makes a person withdraw.
In a study of hospitalized patients who lost their voice after a tracheostomy or laryngectomy, 89% reported difficulty communicating. Many felt frustration (62%) or anxiety (55%). Patients were then offered a tablet with a text-to-speech app. In the group that used it, 53% reported difficulty.
Being able to express pain, thirst, fear or a question helps the person feel heard and get what they need.
Ways to communicate now
No single method works for everything. Reviews of studies suggest most methods help and that combining several is best. The healthcare team and the speech-language pathologist (also called a speech therapist) can guide which to use.
- A yes and no signalAgree on a clear signal, like a nod or a thumbs-up. A blink for yes and closed eyes for no also works. Make sure the staff knows it too.
- Yes-or-no questionsAsk short questions they can answer with that signal: "Are you in pain?" "Are you cold?" Then confirm what you understood.
- Lip reading and gesturesSome people mouth words, point or gesture. Watch calmly and repeat back what you think they said.
- Letter or picture boardsThe person points to letters to spell, or to pictures of needs like pain, thirst or the bathroom. Boards improve communication, though spelling takes time.
- WritingIf they can use their hands, a notepad, a small whiteboard or a phone lets them write what they want to say.
- Tablets or phones that speakSome apps say a typed or tapped phrase out loud. Some can be controlled by touch, gaze or blinking.
Tips for visits
- Get their attentionTouch their shoulder or arm and make eye contact before you speak.
- Glasses and hearing aidsIf they use them, make sure they have them on. Seeing and hearing well makes everything easier.
- Short sentences and patienceUse simple phrases and pause. Give them time to answer and don't rush to guess.
- Keep communication tools at handKeep a notepad, a board or a device nearby that they can use.
- Ask before you leaveBefore you go, ask: "Do you need anything?" "Do you have any questions?"
- Ask what's allowedAsk the nurse which items and devices can be used in the unit.
Talking with the team about their voice
Some people with a tracheostomy can talk again while the tube is still in. Sometimes the team gradually deflates the cuff so air can pass through the vocal cords again. Other times a speaking valve is added: a small part that lets air in through the tube and out through the mouth.
It isn't for everyone. The team usually checks whether the person is awake, stable and able to breathe out around the tube. That decision is made by the healthcare team, who know the case.
As family, you can ask whether it is being considered, what is needed and when it will be reviewed again. You can also share which ways of communicating work best for your loved one.
Where Tocavox helps
Tocavox is a free app for phones and tablets, part of a social project. It shows large buttons with phrases; the person taps one and the device says it out loud, in a natural voice. It comes with health phrases ready, like pain, thirst, cold or going to the bathroom.
It's a free option that the person or their family can set up on their own. It works with a weak or patchy connection: saved phrases keep working even if it drops. It is one more support, alongside the other methods in this guide. To use it, the person needs to be awake and able to tap the screen. In the ICU, always follow the team's guidance on using devices.
Frequently asked questions
Can a person with a tracheostomy talk?
At first, usually not, because air doesn't pass through the vocal cords. Some people can talk again when the team deflates the cuff or adds a speaking valve. It depends on each case and is decided by the healthcare team.
How do you communicate with an intubated patient?
Agree on a yes and no signal, like nodding or blinking, and ask short questions. Gestures, lip reading, letter or picture boards, writing and tablets that speak also help.
Can an intubated patient hear and understand?
Many ICU patients are awake and alert even with the tube in. Talk to them normally and ask the healthcare team about their level of awareness.
Why is my loved one frustrated or anxious in the ICU?
Many patients say it's very hard to make themselves understood. Not being able to talk can cause frustration and anxiety. Having a way to communicate often helps them feel heard.
Can I bring a tablet or phone to the ICU?
It depends on each unit's rules. Ask the nursing staff first which devices are allowed.
Other guides
Sources
- ASHA · Tracheostomy and Ventilator Dependence
- NHS · Tracheostomy: recovery
- Cleveland Clinic · Tracheostomy
- Alberta Health Services · Communication Access: Person who is Ventilated
- Critical Care (2016) · Communicating with conscious and mechanically ventilated critically ill patients: a systematic review
- Nursing in Critical Care (2019) · Communication with patients in intensive care units: a scoping review
- Otolaryngology–Head and Neck Surgery (2022) · Effect of Augmentative Technology on Communication and Quality of Life After Tracheostomy or Total Laryngectomy
This guide is for information only and does not replace the guidance of the healthcare team. · Updated October 11, 2026