Breathing Treatments with a Ventilator

Breathing treatments are helpful for people who have asthma or other types of breathing conditions. The treatments are given to help open the airways and make breathing easier. Breathing treatments can be given through a metered dose inhaler, also known as an MDI, or through a nebulizer. Either method can also be used through a trach or while on a ventilator. This lesson will talk about giving treatments via a trach tube while on a ventilator.

Using a Nebulizer

Gather the supplies:

  • Nebulizer machine
  • Power source
  • Medicine
  • Aerosol tubing, T-connector, medicine cup (nebulizer)

Set it up:

  • Insert the proper dose of medicine into the medicine cup.
  • Place the lid on the cup.
  • Attach the T-connector to the lid.
  • Attach the tubing to the nebulizer machine.
  • Disconnect the ventilator at the connection between the vent filter and the person's trach tubing.
  • Connect the nebulizer T-connector to the vent filter and then connect the other end to the person's trach tube.

Start the treatment:

  • Turn the nebulizer machine on.
  • The medicine in the cup will begin to turn into a fine mist. The person will breathe in the mist as the ventilator gives the usual amount of breaths.
  • Watch the medicine cup to see when all of the mist is gone. When the mist is gone, the treatment is finished.

Stop the treatment:

  • Turn off the nebulizer machine (not the ventilator).
  • Remove the nebulizer from between the vent filter and the trach tubing.
  • Re-attach the regular vent tubing back to the filter and back on to the person's trach tube.
  • The ventilator will continue to give breaths as usual.
  • Sometimes a person may need to be suctioned after a treatment. To do so, please see the "Suctioning" lesson for more information.

Clean the equipment:

Take apart all of the nebulizer supplies and clean them for the next use. See the "Cleaning Equipment" section for more information on this topic.


Sometimes the low pressure alarm will sound because you disconnected and reconnected the tubing for the breathing treatment. Most of the time, this is nothing to be concerned about. If this happens, simply press the "silence" button on the ventilator and watch to make sure the person is not having any breathing problems.

The alarm and flashing light should stop after you re-attach the tubing. However, if it continues to sound/flash, check all vent tubing connections to make sure they are secure. Also, check the cuff pressure in the trach as you were taught in rehabilitation. If it continues to sound/flash after you checked everything and the person is having breathing trouble, give extra breaths via the Ambu Bag and call 911 and the home care company for help. Continue bagging the person until emergency help arrives.

Using a Metered Dose Inhaler

A metered dose inhaler (MDI) gives breathing medicine by a small hand held device. It is very simple to use even if the person is on a ventilator.

Obtain the MDI medicine.

Open the delivery port:

  • Locate the delivery port for the MDI adapter on the vent tubing. The delivery port looks like a little cap that can be lifted up and down. It is near the filter part of the tubing.
  • Open the delivery port and place the inhaler upside down into the port so it attaches securely.

Give the inhaler:

  • Give the inhaler by squirting (push the MDI downwards with the thumb while the rest of the hand cradles the vent tubing) one puff into the vent tubing.
  • Allow the ventilator to deliver 10 breaths.
  • Give the second puff of inhaler.
  • Allow the ventilator to deliver 10 more breaths.

Remove the MDI:

  • Remove the MDI from the vent tubing.
  • Close the delivery port cap.