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, which is 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. Spaulding DOC Guide : page 28tracheostomy-in-adults-1.pdf (
From the American Thoracic

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, including. They may include pulmonologists, nurses, and/ or respiratory therapists. They will manage your loved one’s tracheostomy.

Tracheostomy Care
From Shepherd Center

What kinds of treatments are done for a tracheostomy? 

Your treatment team will provide the care while your loved one is are 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.
There are times when the muscles that help with breathing and coughing may not work well. A suctioning machine called an aspirator may be used to remove things like saliva and mucous that may cause your loved one to have trouble breathing. The suctioning machine is where a tube is used to suck the mucus from the lungs or saliva from the mouth.
Use of an iIn-eExsufflator is another method used to clear the airway and lungs of mucous.  The iIn-eExsufflator is a machine about the size of a shoebox and is oftenbeing 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 mucous with little or no discomfort.
Cleaning a tTrach
This is done regularly by clinicians to keep the trach clean to prevent infections. Your clinicians will show you how this is done so when.   When you go home, you it will be able to important to keep the trach clean to prevent infections as performedthey did in the hospital. Your treatment team will train you how to do this at home. Below is a website that helps you to understand how to do this.
Trach humidification
Your doctor might order extra humidification to your trach based on the person with a DoC and how your loved one with DoCthey responded during the hospital stay.  This is for when your loved one needs humidification to thin out thick secretions or providegiving more humification to the upper airways. A doctor will order a trach collar for humidification. Your respiratory home care company will provide the supplies necessary for this setup. Below is a website that will help you to better understand how this works.

Can my loved one talk with a tracheostomy?

A person who has a tracheostomy is not able to communicate verballyvoice any words.  They can mouth words, but you cannot hear the words.  There is a valve that can be placed in the tracheostomy when a person with DoCdisorders of consciousness is safesaft to be able to tolerate the valve. Your doctor and treatment team will let you know when that may be. Below is a website that explains what that valve is and what it does.

The Passy-Muir® Tracheostomy Speaking Valve allows your loved one with a tracheostomy to potentially voice and produce speech sounds.
Passy-Muir Speaking Valve (PMV), PDF
Válvula de habla Passy Muirr, PDF (Spainsh)
From Memorial Hermann

How do I manage a ventilator or tracheostomy if I take my loved one home?

If the person with a DoC still needs a ventilator or a tracheostomy for a long period of time, families/caregivers can be trained on how to manage this at home.  This section will help you to 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.
A tracheostomy with or without a ventilator can be managed at home and many families do care for tracheostomy at home for their loved one person with DoC. Below are resources to help care for tracheostomy at home.

Why is oral care important?

Oral care is important as it can minimize oral and respiratory infections.

This guide explains why oral care is important, what this care looks like, and what to do:
Oral Care Education, PDF 
From Memorial Hermann