The cuff only needs to be deflated if you are taking the inner cannula out and replacing it with a Passi-Muir valve (used for speaking) and it should not be reinflated until the Passi-Muir is removed and the inner cannula is inserted again. It the cuff is inflated when the Passi-Muir valve is in place, the patient will be unable to exhale. Otherwise, if you are just taking the inner cannula out for trach care, you do not need to deflate the cuff. Hope this helps!