Breathing problems are often caused by injury to the brain stem or the motor cortex; these are areas that control our ability to breathe. Here is a resource about breathing complications that may occur after brain injury.
Breathing After Brain Injury
From Shepherd Center
What can be done to help support my loved one’s breathing?
There are treatments that can be done to improve your loved one’s respiratory function and support. Right after brain injury, the person with a DoC may have trouble breathing on their own; so a breathing tube may be placed through their mouth and attached to a breathing machine called a ventilator.
What is a ventilator?
A ventilator is a machine that moves air through a person’s lungs. It is attached to a tube in the mouth or nose or attached to a trach tube in the person’s throat. It blows air with extra oxygen into the lungs. It has many settings and alarms. Each person's ventilator uses different settings, which are determined by the doctor. Some people need a ventilator all the time; others only need it part of the time. The settings depend on the person’s needs. And as a person with DoC improves their ability to breathe on their own, their physician will start a weaning process.
- Mechanical Ventilation
From the American Thoracic Society
What kinds of treatments are done when on a ventilator?
There are a number of treatments that are done by nurses, doctors, and respiratory therapists that help manage your loved one’s care while on the ventilator. Below is a website that explains some of those treatments.
- Breathing Treatments with a Ventilator
From Shepherd Center
If after several days your loved one still needs some help with breathing, doctors may place a tracheostomy tube. A tracheostomy can be needed even if your loved one needs less support from the ventilator.
What is a tracheostomy?
A tracheostomy is a small surgical opening in a part of your throat called the trachea or windpipe. A tube (often called a trach) is placed into this hole to make it easier to breathe.
- Tracheostomy in Adults (PDF)
From the American Thoracic Society
How is a tracheostomy managed?
While in the hospital, your loved one will have a team of professionals who will manage your loved one’s tracheostomy. They may include pulmonologists, nurses, and/or respiratory therapists.
- Tracheostomy Care
From Shepherd Center
What kinds of treatments are used to manage a tracheostomy?
Your treatment team will provide the care while your loved one is in the hospital. They also may train you as well. Below are some links to some of the treatments. Be sure to check with your treatment team prior to doing this yourself.
Suctioning
There are times when the muscles that help with breathing and coughing may not work well. Saliva and mucus collecting in your loved one's lungs, throat, or mouth may cause them to have trouble breathing. Your treatment team will use a suctioning machine called an aspirator to help, using a tube to suck mucus from your loved one's lungs or saliva from their mouth.
Suctioning: Sterile Technique
From Shepherd Center
In-Exsufflation
Use of an In-Exsufflator is another method used to clear the airway and lungs of mucus. The In-Exsufflator is a machine about the size of a shoebox and is often used in combination with suctioning in some places around the United States. It can be used with a mask, mouthpiece, or directly on the trach tube. It works by using positive and negative pressure to create a "cough" that helps clear mucus with little or no discomfort.
In-Exsufflator Use
From Shepherd Center
Cleaning a Trach
Your loved one's clinicians will clean the trach regularly to prevent infections; and they'll train you how to do it, too. It's very important that you or another caregiver learn how to do this so that when you go home, you will be able to prevent infections for your loved one, just as in the hospital. Below is a website that helps you to understand how to do this.
Tracheostomy Care
From Shepherd Center
Tracheal Humidification
Your doctor might order extra humidification to your loved one's trach, to help thin out thick secretions in the upper airways. The treatment team will provide a trach collar setup for humidification. Once your loved one is home, your respiratory home care company will provide the supplies necessary. Below is a webpage that will help you to better understand how this works.
Tracheal Humidification
From Shepherd Center
Can my loved one talk with a tracheostomy?
A person who has a tracheostomy is not able to communicate verbally (voice any words). They can mouth words, but you cannot hear the words.
In certain circumstances, a Passy-Muir Speaking Valve placed on the trach tube has the potential to help your loved one produce speech sounds. Your doctor and treatment team will let you know when your loved one can safely tolerate the valve. Below is a document that explains what that valve is and what it does.
- Passy-Muir Speaking Valve (PMV), PDF
From TIRR Memorial Hermann - Válvula de habla Passy Muirr, PDF (Spanish)
De TIRR Memorial Hermann
How do I manage a ventilator or tracheostomy if I take my loved one home?
If a person with a DoC needs a ventilator or a tracheostomy for a long period of time, families/caregivers can be trained on how to manage this at home.
Managing a Ventilator at Home
The PDF below will help you understand how to use a ventilator. Be sure to check with your treatment team before doing this on your own as each ventilator is different.
- Ventilator Use at Home (PDF)
From Shepherd Center
Managing a Tracheostomy at Home
Many families do care for their loved one's tracheostomy at home, both with and without a ventilator. Below are resources to help you learn how.
- Tracheostomy: What It Is, Procedure & Purpose
From Cleveland Clinic - Tracheostomy Home Care Booklet | Iowa Head and Neck Protocols
From the University of Iowa Health Care - Guidance for the Care of the Adult Patient with a Tracheostomy
From HSE Ireland