We congratulate ten Hoorn et al. on their systematic review of communication with ICU patients. Their work in defining an algorithm to assist improving communication options for these patients addresses a clear gap in patient-centred care in the ICU. Despite the article giving a good overview of possible communication options for the ventilated ICU patient, we respectfully suggest that the most important communication option is the restoration of the patient’s own voice by enabling airflow through their larynx. This is particularly in the conscious patient cohort—the focus of the review article. We are supported by patient data indicating that verbal communication is the most successful form of communication. Once tracheostomised, a speaking valve (SV) should be considered as the first option for communication as it restores our natural way of communication. Beliefs that cuff deflation required for the restoration of laryngeal function with SV causes atelectasis or would be deleterious in the weaning process have been proven to be unfounded. We currently lack published data on the safe ventilatory parameters for SV use; however, patients in our studies using a SV whilst mechanically ventilated had substantial levels of pressure support and PEEP requirements and were able to communicate using a SV in-line with their mechanical ventilation circuit successfully without any discernible harm to their respiratory function or weaning from the ventilator.